# Obstructive sleep apnea screening performance of the STOP-BANG questionnaire and a home sleep apnea test device in atrial fibrillation ablation candidates

## TL;DR

This study compares the STOP-BANG questionnaire and a home sleep test for detecting sleep apnea in patients undergoing heart rhythm treatment.

## Contribution

The study demonstrates that a home sleep apnea test is more accurate than the STOP-BANG questionnaire for OSA screening in atrial fibrillation patients.

## Key findings

- 84% of atrial fibrillation patients without prior OSA diagnosis had newly identified sleep apnea.
- The home sleep apnea test detected OSA in 97% of cases, outperforming the STOP-BANG questionnaire.
- Severe OSA was diagnosed in 32% of patients, highlighting the importance of OSA screening in this population.

## Abstract

Obstructive sleep apnea (OSA) contributes to the onset and progression of atrial fibrillation (AF) and negatively affects AF ablation outcomes. OSA screening in AF patients is often conducted with the STOP-BANG questionnaire, although its validation is lacking. This study aims to evaluate the screening value of the STOP-BANG questionnaire and a home sleep apnea test (HSAT) device for OSA in patients referred for AF ablation.

Patients referred for their first AF ablation and without prior OSA diagnosis underwent both the STOP-BANG questionnaire and a HSAT device based on peripheral arterial tonometry (PAT). Patients with a PAT-derived apnea-hypopnea index (pAHI) of 5 or more events per hour subsequently underwent clinical polysomnography (PSG). This PSG was used for definitive OSA diagnosis and to determine the diagnostic values of the STOP-BANG and HSAT.

Of 67 patients initially screened with the STOP-BANG and HSAT, 58 completed PSG after excluding those with pAHI < 5/hour or who declined further testing. Among these 58 patients, STOP-BANG (score ≥ 3) correctly screened 84% of cases, while HSAT was more accurate (97%, P-value < 0.002). Among the 67 initially screened patients, 56 (84%) received a new OSA diagnosis. Of these, 21 (38%) had mild OSA, 17 (30%) moderate OSA and 18 (32%) severe OSA.

The high OSA prevalence highlights the importance of OSA screening in patients referred for AF ablation. In this cohort, HSAT demonstrated superior accuracy, compared to the STOP-BANG questionnaire and may be considered the preferred OSA screening tool in outpatient AF clinics.

The online version contains supplementary material available at 10.1007/s10840-025-02131-7.

OSA prevalence among AF ablation patients without a prior OSA diagnosis is 84%.

In AF ablation patients, the STOP-BANG questionnaire has suboptimal performance.

PAT-based HSAT identifies significantly more OSA than STOP-BANG in AF patients.

The online version contains supplementary material available at 10.1007/s10840-025-02131-7.