Abstract:
Despite ongoing research, the association of in-hospital medical
emergency team activation (META) among patients with
atrial fibrillation (AF) who are at risk for obstructive sleep
apnea (OSA) is unclear. Using sleep questionnaires and other
forms of screeners have become useful tools for such patients,
but their sensitivity and specificity, application in various diseases
and risk factors, and therefore, overall usefulness, require
further study.1,2 For instance, a study by El-Sayed2 showed
that the sensitivity of the Berlin, STOP (Snoring, Tiredness,
Observed apnea, high blood Pressure), and STOP-BANG
(Snoring, Tiredness, Observed apnea, high blood Pressure,
BMI, Age, Neck circumference, Gender) questionnaires was
high when screening for OSA; however, the low specificity of
these questionnaires resulted in increased false positives and
failure of exclusion of individuals at low risk.2 Undiagnosed
and untreated OSA is associated with increased in-hospital
morbidity and serves as a risk factor for cardiac complications,
including hypertension, diabetes, and dyslipidemia, and diseases
such as coronary artery disease and AF.1,3 In addition,
pathophysiologic pathways related to OSA, such as alterations
in intrathoracic pressure, intermittent hypoxemia, and autonomic
nervous system fluctuations, may lead to atrial structural
and electrical remodeling, resulting in predisposition to AF.4
Chen et al5 reported that the apnea-hypopnea and desaturation
indices cannot fully represent the severity of OSA in patients
with stroke. Instead, the mean desaturation value during nocturnal
hypoxia must be used. Nocturnal hypoxia due to OSA was
shown to be an independent predictor of AF in patients with
subacute ischemic stroke, and it was concluded that the use of
an overnight pulse oximeter to assess nocturnal hypoxia and to
predict paroxysmal AF in patients with cryptogenic stroke
requires further evaluation, illustrating the importance of reliable
screening methods for OSA and its risk factors.1
