Prevalence and factors associated with atrial fibrillation in older patients with obstructive sleep apnea

Abstract

Purpose This study sought to identify the prevalence and factors associated with atrial fibrillation (AF) in older patients with obstructive sleep apnea (OSA) in China. Methods This was an explorative cross-sectional study. Between January 2015 and October 2017, we continuously recruited 1285 older patients with OSA who underwent overnight polysomnography from sleep centers of multiple hospitals. They were assessed using 12-lead ECG or 24-h dynamic ECG, and their baseline demographics, clinical characteristics, sleep parameters, and medical history were determined. Multivariate binary logistic regression analysis was used to investigate the factors related to AF in these older patients with OSA. 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 reduced diastolic function (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 older patients with OSA. Age, history of drinking, chronic heart disease, diabetes mellitus, and reduced diastolic function are independently related to AF in these patients.

Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea

“…We also found higher levels of CRP and IL‐6 in OSA patients, and this may be due to the repeated hypoxemia experienced by these patients causing oxidative stress and inflammation. Indeed, released reactive oxygen species trigger the activation of nuclear factor kappa B, leading to increased production of CRP, tumor necrosis factor‐α, and IL‐6, which together with adhesion molecules lead to endothelial damage, acting as a substrate for AF 22,23 . In addition, we were also able to confirm that patients with OSA had a greater presence of interstitial fibrosis.…”

“…Indeed, released reactive oxygen species trigger the activation of nuclear factor kappa B, leading to increased production of CRP, tumor necrosis factor-α, and IL-6, which together with adhesion molecules lead to endothelial damage, acting as a substrate for AF. 22,23 In addition, we were also able to confirm that patients with OSA had a greater presence of interstitial fibrosis. Thus, inflammation and fibrosis were increased in this subgroup of patients which may lead to a higher propensity of AF, as demonstrated in several studies.…”

Sex Differences in the Expression of Cardiac Remodeling and Inflammatory Cytokines in Patients with Obstructive Sleep Apnea and Atrial Fibrillation

“…Previous studies have identified elderly individuals and those with comorbidities such as HF, DM, renal failure, and reduced diastolic function as predictors of incident AF in OSA patients [ 31 , 33 , 34 ]. Our study further corroborated these findings, highlighting that advanced age, HFpEF or HFmrEF, increased LA size, elevated E/e’, and decreased LVEF are associated with a heightened risk of AF in OSA patients.…”

Atrial Fibrillation in Obstructive Sleep Apnea Patients: Mechanisms, Risk Factors, and Management Strategies

“…A total of 122 patients (9.5%), with 7.2% having paroxysmal AF and 2.3% with persistent AF, where the prevalence of AF was significantly greater with advanced age (p<0.05). Thus, laying out the evidence that AF is particularly frequent in older patients with OSA [ 35 ].…”