In this research, we introduce a new methodology for atrial fibrillation (AF) diagnosis during sleep in a large population sample at risk of sleep-disordered breathing.
The approach leverages digital biomarkers and recent advances in machine learning (ML) for mass AF diagnosis from overnight-hours of single-channel electrocardiogram (ECG) recording. Four databases, totaling n=3,088 patients and p=26,913 hours of continuous single-channel electrocardiogram raw data were used. Three of the databases (n=125, p=2,513) were used for training a machine learning model in recognizing AF events from beat-to-beat time series. Visit 1 of the sleep heart health study database (SHHS1, n=2,963, p=24,400) was used as the test set to evaluate the feasibility of identifying prominent AF from polysomnographic recordings. By combining AF diagnosis history and a cardiologist’s visual inspection of individuals suspected of having AF (n=118), a total of 70 patients were diagnosed with prominent AF in SHHS1.
Model prediction on SHHS1 showed an overall Se=0.97,Sp=0.99,NPV=0.99 and PPV=0.67 in classifying individuals with or without prominent AF. PPV was non-inferior (p=0.03) for individuals with an apnea-hypopnea index (AHI) ≥15 versus AHI < 15. Over 22% of correctly identified prominent AF rhythm cases were not previously documented as AF in SHHS1.
Individuals with prominent AF can be automatically diagnosed from an overnight single-channel ECG recording, with an accuracy unaffected by the presence of moderate-to-severe OSA. This approach enables identifying a large proportion of AF individuals that were otherwise missed by regular care.

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