Abstract
Background
In this study, we sought to estimate the prevalence of concomitant sleep-disordered
breathing (SDB) in patients with atrial fibrillation (AF) and to systematically evaluate
how SDB is assessed in this population.
Methods
We searched Medline, Embase and Cinahl databases through August 2020 for studies reporting
on SDB in a minimum 100 patients with AF. For quantitative analysis, studies were
required to have systematically assessed for SDB in consecutive AF patients. Pooled
prevalence estimates were calculated with the use of the random effects model. Weighted
mean differences and odds ratios were calculated when possible to assess the strength
of association between baseline characteristics and SDB.
Results
The search yielded 2758 records, of which 33 studies (n = 23,894 patients) met the
inclusion criteria for qualitative synthesis and 13 studies (n = 2660 patients) met
the meta-analysis criteria. The pooled SDB prevalence based on an SDB diagnosis cutoff
of apnea-hypopnea index (AHI) ≥ 5/h was 78% (95% confidence interval [CI] 70%-86%;
P < 0.001). For moderate-to-severe SDB (AHI ≥ 15/h), the pooled SDB prevalence was
40% (95% CI 32%-48%; P < 0.001). High degrees of heterogeneity were observed (I2 = 96% and 94%, respectively; P < 0.001). Sleep testing with the use of poly(somno)graphy or oximetry was the most
common assessment tool used (in 22 studies, 66%) but inconsistent diagnostic thresholds
were used.
Conclusions
SDB is highly prevalent in patients with AF. Wide variation exists in the diagnostic
tools and thresholds used to detect concomitant SDB in AF. Prospective systematic
testing for SDB in unselected cohorts of AF patients may be required to define the
true prevalence of SDB in this population.
Résumé
Contexte
Estimer la prévalence des troubles respiratoires du sommeil (TRS) concomitants à la
fibrillation auriculaire (FA) et examiner systématiquement le mode d’évaluation des
TRS dans ce contexte.
Méthodologie
Nous avons effectué des recherches dans les bases de données MEDLINE, EMBASE et CINAHL
en ciblant une période allant jusqu’à août 2020, afin de trouver des études signalant
des TRS survenus chez des patients atteints de FA, en fonction d’un nombre minimum
de patients fixé à 100. Aux fins d’analyse quantitative, les études devaient comporter
une évaluation systématique des TRS chez des patients consécutifs atteints de FA.
L’estimation groupée de la prévalence a été effectuée à l’aide du modèle à effets
aléatoires. Les différences moyennes pondérées et le rapport de cotes ont été calculés,
lorsque cela était possible, afin d’évaluer le degré d’association entre les caractéristiques
initiales et les TRS.
Résultats
La recherche a permis de recenser 2 758 occurrences, dont 33 études (n = 23 894 patients)
répondant aux critères d’inclusion dans la synthèse qualitative et 13 études (n =
2 660 patients) répondant aux critères de méta-analyse. La prévalence groupée des
TRS déterminée en fonction d’un indice d’apnée-hypopnée [IAH] seuil ≥ 5/heure pour
le diagnostic des TRS était de 78 % (intervalle de confiance [IC] à 95 %: de 70 à
86 %, p < 0,001). En outre, la prévalence groupée des TRS modérés ou sévères (IAH ≥ 15/heure)
atteignait 40 % (IC à 95 % : de 32 à 48 %, p < 0,001). Un degré élevé d’hétérogénéité a été observé (I2 = 96 % et 94 % respectivement, p < 0,001). Le test du sommeil par poly(somno)graphie ou oxymétrie était l’outil d’évaluation
le plus souvent utilisé (n = 22 études, 66 %), mais les seuils diagnostiques n’étaient
pas uniformes.
Conclusions
La prévalence des TRS est très élevée dans un contexte de FA. Les outils et les seuils
diagnostiques servant au dépistage des TRS concomitants à la FA varient grandement.
Le dépistage prospectif et systématique des TRS dans des cohortes non sélectionnées
de patients atteints de FA peut s’avérer nécessaire pour définir la prévalence réelle
de ces troubles au sein de la population considérée.
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Article info
Publication history
Published online: September 30, 2021
Accepted:
September 27,
2021
Received:
September 5,
2021
Footnotes
Study registration: PROSPERO (CRD42020171989).
See page 1854 for disclosure information.
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. All rights reserved.
