Impact of Obstructive Sleep Apnea on Arrhythmia and Quality‐of‐Life Outcomes After Catheter Ablation of Atrial Fibrillation

Background Catheter ablation is a first‐line therapy for atrial fibrillation (AF). We evaluated the impact of obstructive sleep apnea (OSA) on arrhythmia and postablation quality‐of‐life outcomes among AF subtypes. Methods Consecutive patients undergoing AF ablation (2013–2022) at a tertiary center were enrolled and assessed for arrhythmia recurrence over 3‐year follow‐up. A subset of patients enrolled in an automated patient‐reported outcomes platform were assessed for quality of life, including Atrial Fibrillation Severity Score and AF burden (AF duration and frequency scores). Results A total of 7020 patients were included: 3380 with paroxysmal AF (PAF) and 3640 with persistent AF (PersAF), of whom 729 and 943 had OSA, respectively (PAF: age, 66.5±10 years [69% men]; PersAF: age, 66.1±9 years [76% men]). Unlike patients with PersAF, those with PAF and OSA had higher AF recurrence (PAF: no OSA=70% versus OSA=64% [ P <0.01]; PersAF: no OSA=57% versus OSA=60% [ P =0.24]). Baseline OSA was independently associated with a 30% increased AF recurrence risk (hazard ratio, 1.30; P <0.001) among patients with PAF, but not among patients with PersAF. Significant improvement in 1‐year postablation quality of life was noted in both groups irrespective of OSA ( P <0.001 for all comparisons): (1) median AF symptom severity (PAF: no OSA 10→2, OSA 12→4; PersAF: 12→4 in both groups); and (2) median AF duration (PAF: 6.25→0 in both groups; PersAF: 10→0 in both groups); median AF frequency (PAF: 6→0 in both groups; PersAF: 9→0 in both groups). Conclusions Baseline OSA was associated with an increased AF recurrence risk in patients with PAF, but not in those with PersAF. Catheter ablation resulted in improvement of quality‐of‐life metrics irrespective of baseline OSA among AF subtypes.