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Introduction <p>Obstructive sleep apnea (OSA) is common but frequently underdiagnosed in patients with atrial fibrillation (AF), particularly in low- and middle-income countries, where access to polysomnography is limited. This study evaluated the diagnostic accuracy of the STOP-BANG, Berlin, and Epworth Sleepiness Scale (ESS) questionnaires for OSA screening in Vietnamese patients with non-valvular AF.</p> Methods <p>This cross-sectional diagnostic accuracy study was conducted in a tertiary inpatient cardiology department in Ho Chi Minh City, Vietnam. Consecutive adults with chronic non-valvular AF completed the STOP-BANG, Berlin, and ESS questionnaires, followed by overnight unattended type III polysomnography (ApneaLink™, ResMed). OSA was defined as an apnea–hypopnea index ≥ 5 events/hour according to International Classification of Sleep Disorders (ICSD)-3 criteria. Diagnostic performance was assessed using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), predictive values, and likelihood ratios.</p> Results <p>Among 126 participants (median age 61&#xa0;years; 45.2% male vs. 54.8% female), OSA prevalence was 74.6%. STOP-BANG showed the highest diagnostic accuracy (AUC 0.903, 95% confidence interval [95% CI] 0.852–0.954), with sensitivity of 81.9% and specificity of 96.9%. The Berlin questionnaire demonstrated moderate performance (AUC 0.824, 95% CI 0.735–0.914; sensitivity 89.4%; specificity 59.4%). ESS performed poorly in this population (AUC 0.499, 95% CI 0.386–0.613; sensitivity 6.4%).</p> Conclusions <p>STOP-BANG demonstrated superior diagnostic accuracy and practicality for OSA screening in patients with non-valvular AF, supporting its use to guide referrals for confirmatory sleep testing in resource-limited settings.</p>

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Assessment of Clinical Questionnaires for Predicting Obstructive Sleep Apnea in Patients with Non-Valvular Atrial Fibrillation

  • 期刊论文

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  • 发表日期：

    2026年3月13日

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  • Thu Nguyen Ngoc Phuong,
  • Thanh V. Kim,
  • Duong Hiep Ho,
  • Thuong Thanh Phuong,
  • Nguyen Thi Le Trang,
  • Tran Thanh Tuyen,
  • Bui Dan Que,
  • Doan Thi Hoa,
  • Ngo Thi Thanh Thao,
  • Sy Duong-Quy

摘要

Introduction

Obstructive sleep apnea (OSA) is common but frequently underdiagnosed in patients with atrial fibrillation (AF), particularly in low- and middle-income countries, where access to polysomnography is limited. This study evaluated the diagnostic accuracy of the STOP-BANG, Berlin, and Epworth Sleepiness Scale (ESS) questionnaires for OSA screening in Vietnamese patients with non-valvular AF.

Methods

This cross-sectional diagnostic accuracy study was conducted in a tertiary inpatient cardiology department in Ho Chi Minh City, Vietnam. Consecutive adults with chronic non-valvular AF completed the STOP-BANG, Berlin, and ESS questionnaires, followed by overnight unattended type III polysomnography (ApneaLink™, ResMed). OSA was defined as an apnea–hypopnea index ≥ 5 events/hour according to International Classification of Sleep Disorders (ICSD)-3 criteria. Diagnostic performance was assessed using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), predictive values, and likelihood ratios.

Results

Among 126 participants (median age 61 years; 45.2% male vs. 54.8% female), OSA prevalence was 74.6%. STOP-BANG showed the highest diagnostic accuracy (AUC 0.903, 95% confidence interval [95% CI] 0.852–0.954), with sensitivity of 81.9% and specificity of 96.9%. The Berlin questionnaire demonstrated moderate performance (AUC 0.824, 95% CI 0.735–0.914; sensitivity 89.4%; specificity 59.4%). ESS performed poorly in this population (AUC 0.499, 95% CI 0.386–0.613; sensitivity 6.4%).

Conclusions

STOP-BANG demonstrated superior diagnostic accuracy and practicality for OSA screening in patients with non-valvular AF, supporting its use to guide referrals for confirmatory sleep testing in resource-limited settings.