Value of Screening and Treatment of SAHS in the Management of AF Ablation Candidates (SLEEP-AF)

January 24, 2022 updated by: Nicasio Perez Castellano, Hospital San Carlos, Madrid

Value of Screening and Treatment of Sleep Apnea-Hypopnea Syndrome in the Management of Atrial Fibrillation Ablation Candidates

The present prospective cohort study (not randomized) analyses the value of screening and treatment of SAHS in the management of patients with AF refractory to antiarrhythmics drugs, potentially candidates for ablation.

Patients at low risk of suffering from SAHS will follow conventional management of their AF, according to the usual criteria of the Arrhythmia Unit. Patients with high or intermediate risk of SAHS, will undergo respiratory polygraphy. If the result is positive, they will be treated as standard for this syndrome and their heart rate will be monitored for 3 months. After this, the patient's arrhythmic load will be reevaluated differentiating patients into two groups, those that must be ablated from those that have improved their condition and the clinical criteria is no longer ablation but follow-up.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

All patients who meet all the inclusion criteria and none of the exclusion will have a Stop-Bang questionnaire to define the risk of having a SAHS The assessment of results classifies people at high, intermediate or low risk of SAHS. Low-risk patients will follow conventional management according to the usual criteria of the Arrhythmia Unit.

Patients with high or intermediate-risk will be given a Kardia© recorder and they will be instructed to obtain records of their cardiac rhythm every 5 days (at any time) and whenever the symptoms are suggestived of arrhythmia. This allows estimating arrhythmic load baseline in these patients.

They will also will be given a 7-channel home respiratory polygraphy (with pulse oximetry record, naso-buccal air flow through nasal cannula and thermistor, snoring, thoracoabdominal movements and electrocardiogram). The day after conducting the home polygraphic record, the patient will be evaluated in the Pneumology Outpatient Department, where risk factors, symptoms and Epworth's sleepiness scale will be assessed, the results of the cardiorespiratory polygraphic record, interpreted by Pneumology Service will be given , and based on the above, the diagnosis of SAHS will be determined.

Those patients diagnosed with SAHS will be treated in the Pneumology Service according to usual practice (dietary hygienic measures, CPAP, etc.).

During all this time, patients will continue using their rhythm recorders as previously. The overall effect of SAHS treatment on AF recurrences (comparison of arrhythmic load in the previous 3 months with that of the 3 months post-treatment) will be evaluated.

After 3 months of starting the treatment, a follow-up respiratory polygraphy will be carried out, where the relationship between the changes in AHI and desaturation index as well as changes in arrhythmic load will be evaluated.

Once the follow-up respiratory polygraphy is performed, the indication of AF ablation will be reassessed. Patients who continue with symptomatic recurrences of AF refractory to antiarrhythmics will undergo ablation.

It will be analyzed that proportion of patients initially candidates for ablation cease to fulfill conditions for this by a better control of recurrences and "leave the waiting list". Likewise, the results of the ablation of the cohort of patients diagnosed with SAHS and the moderate or high-risk cohort of SAHS, but with negative polygraphy and diagnosis, will be compared.

The arrhythmic load after AF ablation will be analysed, during the blinding period (3 months post-ablation) and one year after the ablation. Patients will continue their SAHS treatment according to the usual practice of the Pneumology Service.

Study Type

Interventional

Enrollment (Anticipated)

50

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Spain
      • Madrid, Spain, 28040
        • Recruiting
        • Hospital Clinico San Carlos
        • Contact:
        • Sub-Investigator:
          • Norberto Torres-Esquivel, MD
        • Sub-Investigator:
          • María-Jesús García-Torrent, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients with paroxysmal or persistent atrial fibrillation
  • Recurrent atrial fibrillation despite treatment with at least one class I or III antiarrhythmic
  • No previous diagnosis of apnea-hypopnea syndrome

Exclusion Criteria:

  • Patients <18 years
  • Pregnant women
  • Doubts about the patient's ability to perform a home respiratory polygraphy
  • Doubts about the patient's ability to acquire rhythm records with the Kardia system (smartphone required)
  • Unavailability for follow-up at our center for at least 1 year.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Non-Randomized
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Patients with negative diagnosis of SAHS
Patients with low risk or negative diagnosis of SAHS will follow conventional management of their AF, according to the usual criteria of the Arrhythmia Unit
Other: Patients with positive diagnosis of SAHS
Patients with intermediate or high risk of SAHS and positive diagnosis
Other: Treatment of SAHS
Patients diagnosed with SAHS will be treated in the Pneumology Service according to usual practice (dietary hygienic measures, CPAP, etc.).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Arrhythmic load
Time Frame: Six months
Rate of time in FA measured with Kardia © recorder
Six months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hospital San Carlos, Madrid

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 5, 2020

Primary Completion (Anticipated)

May 31, 2022

Study Completion (Anticipated)

October 31, 2022

Study Registration Dates

First Submitted

January 16, 2020

First Submitted That Met QC Criteria

October 27, 2020

First Posted (Actual)

October 28, 2020

Study Record Updates

Last Update Posted (Actual)

January 25, 2022

Last Update Submitted That Met QC Criteria

January 24, 2022

Last Verified

January 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 20/023-E

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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