Relationship between Positional Obstructive Sleep Apnea and Excessive Daytime Sleepiness in Patients with Atrial...

Obstructive sleep apnea (OSA) is highly prevalent in patients with atrial fibrillation (AF). Prior studies suggest that excessive daytime sleepiness (EDS), a common symptom of OSA, is less pronounced in patients with AF. This study focused on a subtype of OSA, positional OSA (POSA), and examined its association with EDS overall and separately in patients with and without AF.

This study included 222 OSA patients with and without AF history who underwent in-lab polysomnography. POSA was defined using three criteria: conventional POSA (cPOSA; supine/non-supine apnea-hypopnea index [AHI] ratio ≥ 2), intermediately conservative POSA (iPOSA; supine/non-supine AHI ratio ≥ 3), and exclusive POSA (ePOSA; supine/non-supine AHI ratio ≥ 2 and non-supine AHI < 5 events/h). EDS was determined by an Epworth Sleepiness Scale score ≥ 11. Logistic regression was performed to assess the associations.

Overall, 55.4% of patients had cPOSA, and 43.6% reported EDS. Analysis of the entire cohort showed that patients with cPOSA (adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.26-0.98) or iPOSA (aOR: 0.37, 95% CI: 0.18-0.74) had lower odds of EDS than their non-POSA counterparts. Among patients with AF, cPOSA was associated with lower odds of EDS (aOR: 0.32, 95% CI: 0.11-0.90). Among patients without AF, iPOSA was associated with lower odds of EDS (aOR: 0.28, 95% CI: 0.10-0.75).

The association between POSA and EDS varied by POSA definitions and AF status. The findings suggest that EDS manifests differently by cPOSA status in patients with AF.