Multisetting evaluation of Watch-PAT in obstructive sleep apnea diagnosis in patients with atrial fibrillation.

STUDY

OBJECTIVES

Patients with atrial fibrillation have elevated risk of obstructive sleep apnea (OSA). A peripheral arterial tonometry-based device, the Watch-PAT (WP) has been increasingly used as a home OSA test. We conducted a multisetting evaluation of WP in OSA diagnosis by comparing results from in-laboratory polysomnography (PSG), in-laboratory WP, and home WP in patients with atrial fibrillation.

METHODS

Patients with atrial fibrillation underwent an in-laboratory PSG with concurrent in-laboratory WP and 2 consecutive nights of home WP. OSA was categorized into no OSA, mild, moderate, and severe OSA by apnea-hypopnea index (< 5, ≥ 5 to < 15, ≥ 15 to < 29, ≥ 30 events/h). The primary outcome was OSA severity agreement between in-laboratory PSG vs home WP. Secondary outcomes included the agreement between in-laboratory PSG vs in-laboratory WP, as well as in-laboratory WP vs home WP. Night-to-night variability of consecutive nights of home WP was also evaluated. Results were expressed by Cohen's kappa (κ) for apnea-hypopnea index scoring rules 1a and 1b.

RESULTS

A total of 27 patients were included for analysis. There was slight and fair agreement between in-laboratory PSG and home WP (κ = 0.15, 0.40 for score rule 1a and 1b, respectively), substantial agreement between in-laboratory PSG vs in-laboratory WP (κ = 0.63, 0.71), moderate agreement between in-laboratory WP and home WP (κ = 0.59, 0.59), and almost perfect agreement between first night home WP and second night home WP (κ = 0.87, 0.89).

CONCLUSIONS

We demonstrate overall slight to fair agreement between home WP vs in-laboratory PSG, suggesting inadequate performance against the standard reference test. This should be considered when interpreting the results of home WP. Other evaluations demonstrated moderate agreement for in-laboratory WP and home WP in the classification of OSA severity, substantial agreement between in-laboratory PSG and in-laboratory WP, and almost perfect agreement in the comparison of both home WP.

CITATION: Stafford PL, Roth R, Ferguson J, et al. Multisetting evaluation of Watch-PAT in obstructive sleep apnea diagnosis in patients with atrial fibrillation. J Clin Sleep Med. 2025;21(12):2139-2154.