Obstructive Sleep Apnea as a Risk Factor for Atrial Fibrillation: A Meta-Analysis

Abstract

Objectives To conducted a meta-analysis assessing the relationship between Obstructive Sleep Apnea (OSA) and the risk of Atrial Fibrillation (AF) Methods We searched PUBMED, Medline, and Cochrane Library using the keywords “atrial fibrillation”, “obstructive sleep apnea” and “sleep disordered breathing (SDB)”. All subjects included had established diagnosis of OSA/SDB. We then compared the occurrence of AF versus no AF. Analysis done with Comprehensive Meta-Analysis package V3 (Biostat, USA). Results A total of 579 results were generated. Duplicates were removed and 372 records were excluded based on irrelevant abstracts, titles, study design not consistent with the stated outcome, or full-text unavailable. Twelve studies meeting the inclusion criteria were reviewed in full-text; 2 of these articles were eventually removed due to unconfirmed OSA diagnostic modality, and one was also removed based on a control group inconsistent with the other studies. Therefore, a total of 9 studies were included (n=19,837). Sample sizes ranged from n=160 patients to n=6841 patients. The risk of AF was found to be higher among OSA/SDB versus control group (OR; 2.120, C.I: 1.845–2.436, Z; 10.598 p: <0.001). The heterogeneity observed for the pooled analysis was Q-value; 22.487 df (Q); 8 P-value; 0.004, I-squared; 64.424 Tau2; 0.098, suggesting appropriate study selection and moderate heterogeneity. Conclusion OSA/SDB is strongly associated with AFib confirming the notion that OSA/SDB populations are high risk for development of AF. Prospective studies are needed to ascertain the effect of the treatment of OSA/SDB for the prevention of AF, a growing health burden with serious consequences.

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

“…Obstructive sleep apnea (OSA) is strongly associated with an increased risk of atrial fibrillation (AF). [1][2][3][4][5] The prevalence of OSA in populationbased studies ranges from 3% to 49% while the prevalence is AF c 2018 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd population is up to 21% to 74%. 3,6,7 Several potential mechanisms for OSA-induced AF have been proposed including intermittent hypoxemia and hypercapnia, sympathetically mediated vasoconstriction and surge in blood pressure during an apneic episode leading to left atrial (LA) enlargement, and atrial remodeling and fibrosis due to oxidative stress and inflammatory process.…”

Revisiting Antiarrhythmic Drug Therapy for Atrial Fibrillation: Reviewing Lessons Learned and Redefining Therapeutic Paradigms

“…For example, in a dog model of tachypacing-induced AF, strong vagal nerve stimulation that slows the sinus rate by at least 60% facilitates AF inducibility, but moderate vagal nerve stimulation that slows the sinus rate by only 10–30% does not shorten atrial ERP or affect AF inducibility ( Takei et al, 2001 ; Zhang et al, 2009a ). Low-level stimulation of the extrinsic cardiac autonomic nervous system can suppress AF by inhibiting the autonomic outflow of intrinsic cardiac autonomic nervous system ( Zhang et al, 2009c ; Shen et al, 2011 ; Yu et al, 2011 ). In fact, low-level vagus nerve stimulation (LLVS) can suppress tachypacing-induced adrenergic AF as well was cholinergic-induced AF by mitigating neural remodeling by the intrinsic cardiac autonomic nervous system, thereby preventing and reversing adverse atrial electrical and structural remodeling ( Sheng et al, 2011 ; Kusunose et al, 2014 ; Beaumont et al, 2015 ).…”

“…In the United States, extended longevity from medical advances has led to the projection of up to 15 million patients diagnosed with AF by 2050 (Miyasaka et al, 2006;Colilla et al, 2013). Modifiable risk factors for developing AF within 10 years (Schnabel et al, 2009) include hypertension, diabetes mellitus (Patel et al, 2014), coronary artery disease (Peigh et al, 2020), heart failure, obesity (Thacker et al, 2013), and obstructive sleep apnea (Youssef et al, 2018). Non-modifiable AF risk factors include valvular heart disease (Banerjee et al, 2019), hypertrophic cardiomyopathy (Olivotto et al, 2001), and congenital heart disease (Hu and Lin, 2019).…”

Cardiovascular Disease Risk in Obstructive Sleep apnea: An Update

“…In another study, Patel et al evaluated 3000 patients undergoing catheter ablation of AF and found an 11% significant reduction in recurrence in patients on CPAP versus control [ 32 ]. Furthermore, in a randomized control trial of 18 patients with OSA who had greater than 10 ventricular premature beats during sleep, Ryan et al reported a 58% significant reduction in premature beats during sleep in patients treated with CPAP [ 33 – 37 ].…”