This is the first study to validate a level 3 HSAT (also known as polygraphy) in an AF population, indicating its superiority to other OSA screening tools. Overall, a level 3 HSAT showed the highest diagnostic accuracy at all levels of OSA severity: mild, moderate, and severe. Previously, these devices have been validated only in patients in sleep clinics or in patients suspected to have OSA. We have shown that patients with AF
represent a distinct clinical phenotype when compared with a sleep clinic population and are less likely to have daytime symptoms or obesity, thus supporting the need and clinical relevance of test validation in the target population.
Notably, many traditional OSA risk factors did not perform well as screening tools in this AF cohort, including some that are recommended in clinical guidelines. This finding gives caution to the use of self-reported snoring and daytime hypersomnolence, both of which performed with poor diagnostic accuracy for moderate to severe OSA and with very poor diagnostic accuracy for severe OSA.
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