Chapter 4 60 4.1. Study limitations We did not determine SDB at the time of the index procedure to prevent treatment bias (i.e., CPAP treatment may influence the rate of AF recurrence). However, there are inherent limitations to our study design. There is a potential influence of catheter ablation on the prevalence and severity of SDB. Naruse et al. demonstrated that successful catheter ablation of AF reduced AHI one week after ablation (29). It was hypothesized that reduced airway congestion due to restoration of sinus rhythm would decrease AHI. In contrast, Hoyer et al. demonstrated that catheter ablation had no influence on the prevalence and severity of SDB 6 months after the procedure (30). We determined AHI 12 to 18 months after catheter ablation, and it is unknown how good this correlates with AHI at the index procedure. An alternative would have been to screen for SDB at the time of the index procedure in a doubleblind fashion (patients and physicians unaware of SDB status) for the first year after ablation. Finally, an important limitation is that we used the WatchPAT and not PSG as the gold standard to diagnose SDB. Despite the good correlation between WatchPAT and PSG, this may have influenced the results of our study. 5. Conclusions Undiagnosed SDB is common in patients undergoing catheter ablation of AF and is associated with a two-fold increased risk of AF recurrence. Screening for SDB in patients eligible for catheter ablation of AF may improve patient counselling with respect to the efficacy of catheter ablation. A HSAT-device may be a useful and easy to implement tool to screen for SDB. Funding None. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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