Key result
Between 1999 and 2020, the age-adjusted mortality rate for atrial fibrillation with obstructive sleep apnea increased significantly by an average of 16.69% annually (95% CI: 15.62-17.77).
Why the study?
AF and OSA frequently coexist and increase cardiovascular risk, but national data on mortality trends involving both conditions are scarce.
Observational (n=32,142)
Yes
Effect estimate: AAPC 16.69% (95% CI 15.62-17.77)
Atrial fibrillation-related mortality involving obstructive sleep apnea has increased sharply in the US from 1999 to 2020, particularly among older adults, females, and rural residents.
BACKGROUND: Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist and synergistically increase cardiovascular risk. While their pathophysiologic interplay is well established, national data on mortality trends involving both conditions are scarce. METHODS: We analyzed mortality data from the CDC WONDER platform (1999-2020), including adults aged ≥ 25 years with AF (ICD-10 I48.x) listed as the underlying cause of death and OSA (G47.33) as a contributing condition. Age-adjusted mortality rates (AAMRs) and average annual percent changes (AAPCs) were calculated using Joinpoint regression, stratified by sex, race/ethnicity, urbanization, region, and age. RESULTS: A total of 32,142 AF-related deaths with OSA were identified. The overall AAMR was 0.60 per 100 000, increasing significantly over time (AAPC: 16.69%, 95% CI: 15.62-17.77). Mortality rose across all demographic groups, with the steepest increases among adults ≥ 85 years (AAPC: 19.40%), females (AAPC: 17.77%), rural residents (AAPC: 17.51%), and White individuals (AAPC: 16.95%). Regionally, the Midwest (AAMR: 0.79) and West (0.72) had the highest rates. State-level variation ranged from 1.90 (Oregon) to 0.19 (Mississippi). Despite lower absolute AAMRs among Hispanic and Asian populations, significant upward trends were observed. OSA appears frequently underdiagnosed or untreated in high-risk groups, potentially exacerbating AF mortality. CONCLUSIONS: AF-related mortality involving OSA has risen sharply over the past two decades, outpacing many other cardiovascular trends. These findings underscore the urgent need for integrated AF-OSA screening and treatment pathways, with attention to underserved and disproportionately affected populations.
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Ibrahim et al. (2025) conducted an observational in Atrial fibrillation and obstructive sleep apnea (n=32,142). Time (1999-2020) was evaluated on Age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) (AAPC 16.69%, 95% CI 15.62-17.77). Between 1999 and 2020, the age-adjusted mortality rate for atrial fibrillation with obstructive sleep apnea increased significantly by an average of 16.69% annually (95% CI: 15.62-17.77).
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