Assessing the causal association between obstructive sleep apnea and the risk of atrial fibrillation

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are associated, however the majority of the research to date has been observational in nature and is unable to definitively prove a causative relationship. Using Mendelian randomization (MR) analysis and meta-analysis, this study attempts to assess the causal link between AF and OSA in more detail. Six genome-wide association studies (GWAS) datasets were subjected to de novo 2-sample MR analysis, and a series of analyses were carried out to guarantee the validity of the MR findings. In order to better elucidate the relationship between OSA and AF, a meta-analysis was performed on the inverse-variance weighted results of all MR analyses. GWAS data from several large-scale cohorts suggested an increased risk of atrial fibrillation (AF) associated with obstructive sleep apnea (OSA), whereas results from other GWAS datasets showed no clear evidence supporting a causal relationship. After excluding GWAS data that may contain false positive results, the meta-analysis results revealed a causal relationship between OSA and AF (odds ratio = 1.0030, 95% confidence interval = 1.0007–1.0054, P < .01). This study provides support for a causal relationship between OSA and AF. Efforts should be made to screen for AF in patients with OSA, elucidate its clinical significance, and explore its role as a potentially modifiable risk factor.