Impact of Obstructive Sleep Apnea On In-Hospital Outcomes in Patients With Atrial Fibrillation: A Retrospective Analysis of the National Inpatient Sample

Abstract

BackgroundObstructive sleep apnea (OSA) is frequently seen with atrial fibrillation (AF) and is associated with increased cardiovascular morbidity, including hypertension, congestive heart failure, ischemic heart disease, and stroke. However, the impact of OSA on in-hospital outcomes of patients with AF is unclear. MethodologyAll patients aged ≥18 admitted primarily for AF between January 2016 and December 2017 were identified in the National Inpatient Sample database. They were then categorized into those with OSA and those without OSA. The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest. ResultsOf 156,521 primary AF hospitalizations, 15% of the patients had OSA. Baseline characteristics revealed no race disparity between the two groups. However, compared to those without OSA, the OSA group was younger and had a significantly higher proportion of males, obesity, heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia. Long-term anticoagulation and inpatient cardioversion were also higher in the OSA group. Following propensity matching, inpatient mortality was similar between the two groups [0.54% in OSA vs. 0.51% in non-OSA; adjusted odds ratio = 1.06 (95% confidence interval = 0.82-1.35)]. Similarly, OSA was not significantly associated with acute kidney injury, cardiac arrest, gastrointestinal bleed, acute stroke, or length of stay. However, the OSA group was less anemic and required fewer in-hospital blood transfusions. ConclusionsAlthough OSA is highly prevalent in AF patients, inpatient mortality and cardiovascular outcomes such as cardiac arrest, stroke, or major bleeding were similar in AF patients with or without concomitant OSA with no significant differences in length of stay.

Role of sleep disorders in patients with cardiovascular disease: A systematic review

“…A total of 66795 references were identified in the two databases. After careful reading, 78 articles were included in this systemic review [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] ...…”

“… Combie mid quality (+)OSA(+)PVI(+) Triggers N = 43/49 ± 12yrs (−)OSA(+)PVI(+) Triggers N = 43/54 ± 14yrs (−)OSA(+)PVI(−) Triggers N = 48/59 ± 12yrs (+)OSA(+)PVI(−) Triggers N = 50/51 ± 15yrs 5 Bitter2009 [ 84 ] Germany Cross-sectional study AF SDB N = 150/66.1 ± 1.7yrs Cardiorespiratory polygraphy Patients with AFib were found to have not only a high prevalence of obstructive sleep apnea, as has been described previously, but also a high prevalence of CSA/CSR. Combie mid quality CSA/CSR N = 47/64.1 ± 5.0yrs OSA N = 64/67.4 ± 2.1yrs No SDB N = 39/65.4 ± 4.8yrs 6 Brgdar2021 [ 90 ] USA Retrospective study AF OSA N = 156,521 ICD-10 Although OSA is highly prevalent in AF patients, inpatient mortality and cardiovascular outcomes such as cardiac arrest, stroke, or major bleeding were similar in AF patients with or without concomitant OSA with no significant differences in length of stay. NOS high quality Pre-match OSA N = 23,678/65.18 ± 10yrs Non-OSA N = 132,843/71.4 ± 13yrs Post-match OSA N = 23,678/65.18 ± 12.7yrs Non-OSA N ...…”

The effect of obstructive sleep apnea on the cardiovascular system

“…There are positive results in reducing symptoms of OSA as well as hypertension and episodes of AF. In addition, studies show new methods of curing OSA by stimulating the hypoglossal nerve, but more research is needed (23), (24) [62,63]. Moreover, there are also simple methods of reducing negative effects of OSA like quitting alcohol, positional therapy, smoking cessation and weight loss (23) [62].…”

“…Despite the fact that OSA is common in AF patients, hospital death and cardiovascular outcomes like as cardiac arrest, stroke, or severe hemorrhage were similar in AF patients with and without OSA, with no significant variations in length of stay. OSA is known to reduce the efficacy of both pharmaceutical and catheter-based pulmonary vein isolation (PVI) antiarrhythmic therapy techniques in AF patients [23]. Aside from medicines, direct current cardioversion and RFA, CPAP therapy, which may be advantageous for people with AF, might be a therapeutic option [24].…”

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

“…Patient hospitalization records for 2019 were retrieved from the NIS, the largest in-patient healthcare database in the USA, developed and maintained by the Healthcare Cost and Utilization Project (HCUP) under the sponsorship of the Agency for Healthcare Research and Quality. The details of the NIS database have been described previously [26].…”