Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea

Hendrikx, Tijn; Sundqvist, Martin; Sandström, Herbert; Sahlin, Carin; Rohani, Morteza; Al‐Khalili, Faris; Hörnsten, Rolf; Blomberg, Anders; Wester, Per; Rosenqvist, Mårten; Franklin, Karl A.

doi:10.1371/journal.pone.0171575

Cited by 23 publications

(15 citation statements)

References 36 publications

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“…Previous studies showed that DM, severity of OSAS, lower sleep efficiency, and heart failure were significantly associated with the incidence of AF in patients with OSAS [7,10,24]. This study confirmed previous findings that DM, lower sleep efficiency, and lower LVEF were independent predictors of AF occurrence in patients with OSAS.…”

Section: Discussionsupporting

confidence: 90%

“…There is a growing body of evidence suggesting that OSAS is considered a risk factor for AF [7]. The incidence of AF in OSAS patients varies from 7.6% to 20% in different studies investigating different populations and using different detection methods [7,9,10]. There are some reports on the relationship between AF and OSAS that show the incidence of AF is associated with OSAS severity, that AF patients with OSAS have a worse prognosis (a higher AF recurrence rate) whether receiving medication or ablation therapy [6,7] and that the treatment strategy (e.g., nasal continuous positive airway pressure) for OSAS may decrease the number of AF attacks [11].…”

Section: Introductionmentioning

confidence: 99%

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GJA1 Expression and Left Atrial Remodeling in the Incidence of Atrial Fibrillation in Patients with Obstructive Sleep Apnea Syndrome

Chen

Chang

et al. 2021

Biomedicines

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Obstructive sleep apnea syndrome (OSAS) is an important risk factor for atrial fibrillation (AF). GJA1 gene encoding connexin43, a major protein in cardiac gap junctions, plays a crucial role in the synchronized contraction of the heart and in cardiac arrhythmia. However, little is known regarding the role of GJA1 expression in the incidence of AF in patients with OSAS. All prospectively enrolled OSAS patients underwent polysomnography, electrocardiography, a 24-hour Holter test, and echocardiography. Moderate-to-severe OSAS was defined as an apnea-hypopnea index (AHI) ≥ 15. Exosomes were purified from the plasma of all OSAS patients and incubated in HL-1 cells to investigate the effect of exosomes from patients with and without AF on GJA1 expression. A total of 129 patients were recruited for this study; 26 were excluded due to an AHI < 15. Of the 103 enrolled patients, 21 had AF, and 82 did not. Multivariate analysis showed diabetes mellitus, lower sleep efficiency, lower left ventricular ejection fraction, and larger left atrial (LA) size were independent predictors of AF occurrence in OSAS patients. The area under the receiver operating characteristic curve for LA with a size ≥ 38.5 mm for predicting AF occurrence in OSAS patients was 0.795 (95% confidence interval [0.666, 0.925]); p < 0.001). GJA1 expression in HL-1 cells incubated with exosomes from OSAS patients with AF was lower than that with exosomes from patients without AF after controlling for age and sex and was negatively correlated with the AHI and oxygen desaturation index (ODI), especially during the non-rapid eye movement period (NREM) of OSAS patients with AF (all p < 0.05). LA size was an independent predictor of AF occurrence in OSAS patients. The AHI and ODI in the NREM period of OSAS patients with AF were negatively correlated with GJA1 expression in HL-1 cells, which offers a hint that GJA1 may play a crucial role in the development of AF in patients with OSAS.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

GJA1 Expression and Left Atrial Remodeling in the Incidence of Atrial Fibrillation in Patients with Obstructive Sleep Apnea Syndrome

Chen

Chang

et al. 2021

Biomedicines

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“…The prevalence of AF is reported to be approximately 7.6% in patients with suspected OSA, and it increases with the severity of OSA [16] . However, the prevalence in elderly patients with OSA has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Factors Associated With Atrial Fibrillation in Elderly Patients With Obstructive Sleep Apnea

Wang

Gao

et al. 2021

Preprint

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Purpose: This study sought to identify the prevalence and factors associated with atrial fibrillation (AF) in elderly patients with obstructive sleep apnea (OSA) in China. Methods: Between January 2015 and October 2017, we recruited 1285 elderly patients with OSA who underwent overnight polysomnography at sleep centers of multiple hospitals. They were assessed using 12-lead ECG or 24-hour dynamic ECG, and their baseline demographics, clinical characteristics, sleep parameters, and medical history were determined. Binary logistic regression analysis was used to investigate the factors related to AF in these elderly patients. Results: The clinician classified 122 (9.5%) patients as having AF. The prevalence of AF significantly increased with age (p＜0.05) but did not significantly differ between the mild, moderate, and severe OSA groups. Additionally, the prevalence of paroxysmal AF was 7.2% among the overall study population, and it increased with OSA severity or advanced age (p＜0.05). Persistent AF was noted in 2.3% participants, and the prevalence also increased with age. The logistic regression analysis showed that age (OR=1.054, 95%CI: 1.027-1.018, p＜0.001) , history of drinking (OR=1.752, 95%CI: 1.070-2.867, p＜0.05), chronic heart disease (OR=1.778, 95%CI: 1.156-2.736, p＜0.01), diabetes mellitus (OR=1.792, 95%CI: 1.183-2.713, p＜0.01), and cardiac dysfunction (OR=2.373, 95%CI=1.298-4.337, p＜0.01) were relevant to AF among participants with OSA.Conclusion: The prevalence of AF is significantly common in elderly patients with OSA. Age, history of drinking, chronic heart disease, diabetes mellitus, and cardiac dysfunction are independently related to AF in these patients.

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“…Screening is especially necessary for populations with an underlying risk factor for stroke or systemic embolism, such as hypertension, diabetes mellitus (Kishimoto et al, 2016), or sleep apnea (Hendrikx et al, 2017). The ESC guidelines recommend AF screening in accordance with the CHA 2 DS 2 -VASc score (Kirchhof et al, 2016).…”

Section: Wristwatch-based Pwmmentioning

confidence: 99%

Performance of an atrial fibrillation detection algorithm using continuous pulse wave monitoring

Kashiwa

Koyama

Miyamoto

et al. 2018

Noninvasive Electrocardiol

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Background: Detecting asymptomatic and undiagnosed atrial fibrillation (AF) is increasingly important. Recently, we developed a wristwatch-based pulse wave monitor (PWM; Seiko Epson, Japan) capable of long-term recording, with an automatic diagnosis algorithm that uses frequency-based pulse wave analysis. The aim of this study was to evaluate the validity of continuous pulse wave monitoring for detection of AF. Methods: During the electrophysiological study (EPS) in patients with AF, simultaneous pulse wave monitoring and Holter electrocardiograms (ECG) were recorded (n = 136, mean age 62.7 ± 10.9 years). The diagnostic accuracy of the PWM for AF was compared to the Holter ECG diagnosis. Standard performance metrics (sensitivity [Se], specificity [Sp], positive predictive value [PPV], and negative predictive value [NPV]) were calculated. The duration-based measurements were based on the diagnosis concordance ratios for the duration of time between diagnosis detected by the PWM and true diagnosis by the Holter ECG (AF or not AF). The episode-based performance metrics were based on the proportion of episodes appropriately detected with the PWM relative to episodes determined by the Holter ECG. Results: The total recording time was 1,542,770 s (AF: 270,945 s). A high diagnostic Sp (patient average: 96.4%, cumulative: 97.7%) and NPV (patient average: 95.1%, cumulative: 96.8%) were obtained in the duration-based results. In the episode-based metrics, all indices significantly improved with longer AF episode durations.Conclusions: Continuous pulse wave monitoring can provide accurate and dependable information to aid in AF diagnosis. A high validity in confirming freedom from AF was shown by a high NPV.

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Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea

Cited by 23 publications

References 36 publications

GJA1 Expression and Left Atrial Remodeling in the Incidence of Atrial Fibrillation in Patients with Obstructive Sleep Apnea Syndrome

GJA1 Expression and Left Atrial Remodeling in the Incidence of Atrial Fibrillation in Patients with Obstructive Sleep Apnea Syndrome

Prevalence and Factors Associated With Atrial Fibrillation in Elderly Patients With Obstructive Sleep Apnea

Performance of an atrial fibrillation detection algorithm using continuous pulse wave monitoring

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