title: Usefulness of the SAME-TT2R2 score to predict anticoagulation control on VKA in patients with atrial fibrillation and obstructive sleep apnea.
abstract: BACKGROUND
  Oral anticoagulation is crucial for the prevention of stroke and thromboembolism in atrial fibrillation (AF). One of the comorbidities potentially affecting thromboembolic risk and anticoagulation effectiveness is obstructive sleep apnea (OSA). The objective of this study was to establish if presence of OSA is associated with poor expected benefit from vitamin K antagonist (VKA) therapy as assessed using the SAMe-TT2R2 score.
  
  
  METHODS
  We studied AF patients planned for invasive electrophysiological procedures. All patients had a whole night polygraphy performed for the diagnosis of OSA, and their SAMe-TT2R2 score was calculated.
  
  
  RESULTS
  We studied 211 AF patients (mean age = 57.1 ± 10.2 years, 62.6% males). OSA with apnea-hypopnea index (AHI) ≥ 15/h was found in 48 (22.7%) patients. Mean SAMe-TT2R2 score in non-OSA patients was 1.4 ± 0.9, compared to mild OSA patients, 1.5 ± 0.9; moderate OSA patients, 1.9 ± 1.1; and severe OSA patients, 2.8 ± 0.6. A significantly higher percentage of patients with SAMe-TT2R2 ≥ 2, indicating poor predicted INR control on VKAs, was found with increasing AHI category (37% vs. 41% vs. 57% vs. 100%, respectively). Patients with poor predicted anticoagulation control (SAMe-TT2R2 ≥ 2) had a higher prevalence of OSA. There was a lower proportion of patients with TTR > 70% among patients with moderate/severe OSA compared to no/mild OSA (13.6% vs. 29.6%, p = 0.03).
  
  
  CONCLUSIONS
  SAMe-TT2R2 scores in patients with OSA are substantially higher than in those without sleep-disordered breathing. The mean SAMe-TT2R2 score, as well as the percentage of patients with SAMe-TT2R2 score ≥ 2, suggests poor predicted anticoagulation control on VKA rises along with the AHI. There was a lower proportion of patients with TTR > 70% among patients with moderate/severe OSA, compared to no/mild OSA.
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. Electronic address: filip.szymanski@wum.edu.pl.
authors.forename: Filip M
authors.initials: FM
authors.lastname: Szymanski
authors.affiliation: City Hospital, University of Birmingham Institute of Cardiovascular Sciences, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Platek
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Karpinski
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D019934:International Normalized Ratio / Q000592:standards; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Atrial fibrillation; Obstructive sleep apnea; SAMe-TT(2)R(2)