Change in sleep apnea parameters in patients with atrial fibrillation undergoing pulmonary vein isolation: interim analysis of the AAHIi study
P S Basiukiewicz, P FutymaAbstract
Purpose
Obstructive sleep apnea (OSA) commonly coexists with atrial fibrillation (AF), worsening arrhythmia burden, promoting recurrence, and impairing rhythm-control efficacy, including post-ablation outcomes. OSA severity correlates with poorer AF control, while AF exacerbates OSA via atrioventricular dyssynchrony, loss of atrial kick, fluid shifts and rapid and slow ventricular rates. The AAHI study evaluates changes in polygraphic sleep parameters, particularly apnea-hypopnea index (AHI), during rhythm-control therapy in paroxysmal AF patients scheduled for pulmonary vein isolation (PVI).
Methods
The prospective observational AAHI study enrolls consecutive AF patients undergoing PVI with anticipated enrollment target equal 100. All patients undergo polygraphy (PG) with pulse oximetry, heart rate, thoracic/abdominal respiratory movements, and nasal airflow measurements 1-month before and 1 month after PVI. The primary endpoint is change in AHI and oxygen desaturation index (ODI) after PVI compared with baseline values.
Results
To date (2025-NOV-08) a total of 44 patients were enrolled in the study, of whom 16 (36.3%) have completed both pre- and at least one of two post-PVI assessments to date. Based on baseline PG OSA was diagnosed in 39 (88%) of participants. Of these 13 (33.3%) had mild, 14 (35.8%) moderate, 12 (30.7%) severe OSA. In this interim cohort of 16 patients, the mean AHI decreased from 19.0±10.8 before PVI to 15.0±8.5 after PVI (p=0.12). The mean oxygen desaturation index (ODI) showed a similar trend, decreasing from 19.4±10.3 to 14.7±7.5 (p=0.14).
Conclusions
Vast majority of patients referred for PVI suffer from OSA with only small minority has an established diagnosis prior to screening. There is a trend toward a reduction in OSA severity in patients after PVI. Further analysis in a larger cohort is warranted to confirm these findings and to clarify the underlying pathophysiological mechanisms.