Obstructive sleep apnoea and cardiovascular risk in atrial fibrillation: a health system-based cohort study

Objective Obstructive sleep apnoea (OSA) and atrial fibrillation (AF) frequently coexist and share pathophysiological pathways that increase cardiovascular risk. This study examined whether OSA confers additional risks of heart failure (HF), ischaemic heart disease (IHD) and stroke or transient ischaemic attack (TIA) among individuals with AF. Methods Using the UK Clinical Practice Research Datalink (2000–2022), we identified 720 923 adults with AF. Three propensity score-matched cohorts were constructed for HF (n=26 111), IHD (n=23 559) and stroke/TIA (n=29 770). Competing-risk Cox proportional hazards models were applied to compare incident cardiovascular outcomes between individuals with and without OSA. Results Baseline characteristics were well balanced after matching. Over a median follow-up of 2.0 years (IQR 0.9–4.8), OSA was associated with higher risks of HF (adjusted HR (aHR) 1.24, 95% CI 1.05 to 1.46) and IHD (aHR 1.35, 95% CI 1.05 to 1.74), whereas no statistically significant association was observed for stroke/TIA (aHR 0.83, 95% CI 0.59 to 1.16). The excess risks for HF and IHD were more pronounced among women than men. Conclusions Among individuals with AF, coexisting OSA is associated with additional risks of HF and IHD but not stroke/TIA, with stronger associations observed in women. These findings highlight the importance of recognising and managing OSA as part of comprehensive cardiovascular prevention and secondary risk reduction strategies in patients with AF.