Key result
Obstructive sleep apnea was an independent risk factor for non-CNS embolism (HR 5.42) in patients with atrial fibrillation, but did not significantly increase the risk of stroke.
Why the study?
Sleep apnea is an underdiagnosed risk factor for AF, and whether OSA is correlated with thrombotic risk in AF remains unclear.
Does obstructive sleep apnea increase the risk of stroke or non-CNS embolism in patients with atrial fibrillation?
Cohort (n=1,990)
Yes
Does obstructive sleep apnea increase the risk of stroke or non-CNS embolism in patients with atrial fibrillation?
Hazard Ratio: 5.42 (95% CI 1.34–22.01)
Absolute Event Rate: 4.3% vs 0.6%
p-value: p=0.02
In patients with atrial fibrillation, comorbid obstructive sleep apnea is independently associated with a significantly increased risk of non-CNS systemic embolism, highlighting the need for targeted screening and management.
BACKGROUND: Sleep apnea is a risk factor for atrial fibrillation (AF) but it is underdiagnosed. Whether obstructive sleep apnea (OSA) is correlated with thrombotic risk in AF remains unclear. The aim of the present study was to analyze the clinical characteristics and assess the thrombotic risk of AF with OSA. METHODS: In the present registry study,1990 consecutive patients with AF from 20 centers were enrolled. The patients were divided into 2 groups depending on whether they presented with both AF and OSA. All the patients were followed up for 1 year to evaluate the incidences of stroke and non-central nervous system (CNS) embolism. RESULTS: Of the 1990 AF patients, 70 (3.5%) and 1920 (96.5%) patients were in the OSA group and non-OSA group, respectively. The results of the multivariate logistic model analysis showed that male sex, body mass index (BMI), smoking, and major bleeding history were independent risk factors for patients with AF and OSA. The comparison of the Kaplan-Meier curves using the log-rank test revealed that AF with OSA was correlated with an increased risk of non-CNS embolism (p < 0.01). After multivariate adjustments were performed, OSA remained an independent risk factor for non-CNS embolism (HR 5.42, 95% CI 1.34-22.01, p = 0.02), but was not correlated with the risk of stroke in patients with AF. CONCLUSIONS: The present study revealed that male sex, high BMI values, smoking, and major bleeding history were independent risk factors for patients with AF and OSA. Moreover, OSA was an independent risk factor for non-CNS embolism in AF. Our results indicate that non-CNS embolism requires focus in patients with AF and OSA.
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Xu et al. (2022) conducted a cohort in Atrial fibrillation (n=1,990). Obstructive sleep apnea vs. No obstructive sleep apnea was evaluated on Non-central nervous system (CNS) embolism (HR 5.42, 95% CI 1.34-22.01, p=0.02). Obstructive sleep apnea was an independent risk factor for non-CNS embolism (HR 5.42) in patients with atrial fibrillation, but did not significantly increase the risk of stroke.
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