Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study

Konstanze Betz, Dominique V.M. Verhaert, Monika Gawalko, Astrid N.L. Hermans, Zarina Habibi, Nikki A.H.A. Pluymaekers, Rachel M.J. van der Velden, Marloes Homberg, Suzanne Philippens, Maartje J.M. Hereijgers, Bianca Vorstermans, Sami O. Simons, Dennis W. den Uijl, Sevasti Maria Chaldoupi, Justin G.L.M. Luermans, Sjoerd W. Westra, Theo Lankveld, Reindert P. van Steenwijk, Bernard Hol, Ulrich SchottenKevin Vernooy, Jeroen M. Hendriks, Dominik Linz

Research output: Contribution to journalArticlepeer-review

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Background: Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. 

Aim: We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. 

Methods: Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea–hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening. 

Results: Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573–0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672–0.805) in the overall population.

Conclusion: AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. 

Trial registration number: ISOLATION was registered NCT04342312, 13-04-2020. Graphical Abstract: [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)834-845
Number of pages12
JournalClinical Research in Cardiology
Issue number6
Early online date11 Feb 2023
Publication statusPublished - Jun 2023


  • Ablation
  • Atrial fibrillation
  • mHealth
  • Sleep apnoea
  • Sleep-disordered breathing
  • STOP-Bang questionnaire


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