Impact of obstructive sleep apnea on arrhythmic risk in ischemic heart disease and hypertrophic cardiomyopathy: insights from a large national cohort

Background Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing condition associated with atrial fibrillation (AF) and cardiovascular morbidity. Its impact on life-threatening arrhythmic events, including cardiac arrest (CA) and ventricular fibrillation (VF), in patients with ischemic heart disease (IHD) and hypertrophic cardiomyopathy (HCM) remains incompletely understood. Objectives We aimed to evaluate the association between OSA and arrhythmic outcomes in patients with IHD or HCM and to explore the potential role of AF as an intermediate pathway. Methods Using the National Inpatient Sample (2016–2020), we identified adults with IHD or HCM. OSA and arrhythmic events were defined by ICD-10 codes. Baseline characteristics were compared, and 1:1 propensity score matching (PSM) was performed. Multivariate logistic regression assessed the relationship between OSA and AF, AF and the composite endpoint of CA/VF, and the combined effect of OSA and AF in hierarchical models. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results Among 20,590 patients, 3,974 (19.3%) had OSA. OSA was independently associated with AF (OR 1.37, 95% CI 1.15–1.62, p < 0.001). AF was a strong predictor of CA/VF (OR 13.88, 95% CI 10.70–18.01, p < 0.001). In hierarchical models, the effect of OSA on CA/VF was attenuated and non-significant (OR 1.14, 95% CI 0.96–1.36, p = 0.13), whereas AF remained robustly associated. Conclusions In patients with IHD or HCM, OSA was associated with a higher prevalence of AF, which may represent an important intermediate pathway associated with life-threatening arrhythmic events.