Risk of Major Cardiovascular and Neurologic Events with Obstructive Sleep Apnea among Patients with Atrial Fibrillation

Structured Abstract Background Obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF). However, it remains unclear whether OSA is independently associated with worse cardiovascular and neurological outcomes in patients with AF. Method We used the ORBIT-AF I and ORBIT-AF II to conduct a retrospective cohort study of 22,760 patients with AF with and without OSA. Adjusted multivariable Cox proportional hazards models was used to determine whether OSA was associated with increased risk for major adverse cardiac and neurologic events (MACNE) (cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non-CNS embolism (stroke/SE), and new-onset heart failure) , combined and individually. Results A total of 4,045 (17.8%) patients had OSA at baseline. Median follow-up time was 1.5 (IQR: 1-2.2) years and 1,895 patients experienced a MACNE event. OSA patients were younger (median [IQR] 68 [61-75] years vs. 74 [66-81] years, were more likely male (70.7% vs. 55.3%), and had increased BMI (median 34.6 kg/m2 [29.8-40.2] vs. 28.7 kg/m2 [25.2-33.0]). Those with OSA had a higher prevalence of concomitant comorbidities such as diabetes, chronic obstructive pulmonary disease, and heart failure. OSA patients had higher use of antithrombotic therapy. After adjustment, the presence of OSA was significantly associated with MACNE (HR: 1.16 [95% CI: 1.03-1.31], p=0.011). OSA was also an independent risk factor for stroke/SE beyond the CHA2DS2-VASc risk factors (HR: 1.38 [95% CI 1.12-1.70], p=0.003), but not cardiovascular death, myocardial infarction, new-onset heart failure or major bleeding. Conclusion Among patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.