Obstructive Sleep Apnea Severity and PAP Compliance in Atrial Fibrillation Patients

Obstructive Sleep Apnea (OSA) is highly prevalent in patients with atrial fibrillation and successful treatment has been shown to reduce morbidity in this high-risk group. This study evaluates the effect of OSA severity on treatment compliance. Methods: Electronic medical records were reviewed for sleep study variables (Apnea-hypopnea index -AHI), the prescribed positive airway pressure device, and PAP compliance. The OSA diagnoses were categorized into 3 categories based on the patients’ AHI. An AHI of >5-<15 was considered “Mild”. An AHI of 15-<30 was considered “Moderate”. An AHI of 30 or more was considered “Severe”. At 3 months, compliance was reviewed. PAP usage of 4 or more hours for 70 % or more of the nights was considered compliant. Chi-square test was performed to compare the three OSA groups for compliance. Results: A total of 222 patients met inclusion criteria and 192 patients had OSA. Mild OSA was observed in 35 patients, moderate OSA in 52 patients and severe OSA in 105 patients. Among patients who were started on therapy, 95% were on CPAP and 10 % were on BIPAP. There was a statistically significant difference in PAP compliance across OSA severity groups (Mild 45% vs Moderate 61 % vs Severe 67%, P-value 0 .03). Conclusion: Severe OSA patients were more compliant with PAP as compared to mild OSA patients; there is a significant upward trend in compliance withincreasing OSA severity. As even mild OSA can affect atrial fibrillation outcomes, barriers to treatment compliance in this group need to be evaluated.