Obstructive sleep apnea screening protocol and safety measures : advancing treatment quality and reducing medical emergency team activation in patients with atrial fibrillation, respiratory diseases, and frailty

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