Undiagnosed OSA and AF recurrence after ablation (OSA-AF study) 57 diagnosed SDB were similar, except patients with previously diagnosed SDB more often used amiodarone (Supplemental table 1). 3.3. Performance of SDB screening questionnaires In total, 95 (91%) and 102 (98%) patients completed the STOPBANG questionnaire and the ESS questionnaire, respectively. An abnormal STOP-BANG score (intermediate or high-risk score) was present in 61 patients (64%). A higher proportion of patients with SDB had an abnormal STOP-BANG score in comparison to patients without SDB (79% versus 56%, P = 0.02). An abnormal STOP-Bang score had a sensitivity of 79% and specificity of 44% for the detection of SDB (AHI ≥ 15) with a positive predictive value (PPV) of 44% and negative predictive value (NPV) of 79%. The diagnostic accuracy of the test was 57%. The area under the receiver operating characteristic curve (AUC) was 0.62 denoting a poor diagnostic discrimination. When using only the high-risk STOP-BANG score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 35%, 76%, 44%, 68%, and 61%, respectively. Thus, specificity improved at the expense of sensitivity. Fig. 4 provides a comparison of the AHI values for the different STOP-BANG classifications. The median AHI values were statistically different between STOP-BANG groups: patients with low, intermediate, and high-risk STOP-BANG score had a median AHI of 8.7 (IQR, 4.1–14.3), 10.9 (IQR, 6.0–22.8), and 14.9 (IQR, 9.1–24.5), respectively (P = 0.03). The mean ESS score was 4.0 ± 3.6. Excessive daytime sleepiness (ESS ≥ 11) was present in 7 patients (7%). There was no difference in excessive daytime sleepiness between patients with and without SDB (8% versus 6%, P = 0.75). Using an ESS score ≥ 11, the sensitivity was 8% and the specificity was 94% for detecting SDB (AHI ≥ 15), with a PPV of 43% and NPV of 63%. The diagnostic accuracy of an ESS score ≥11 was 62%. The AUC was 0.51 denoting a poor diagnostic discrimination. 4. Discussion The present study demonstrates that a large proportion of patients undergoing catheter ablation of AF have undiagnosed SDB. In this specific population, the STOP-Bang and ESS questionnaires do not accurately predict the presence of SDB. Importantly, undiagnosed SDB was associated with a two-fold higher risk of AF recurrence in the first year after catheter ablation. 4
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