EC Pulmonology and Respiratory Medicine

Study Objectives: Obstructive sleep apnea (OSA) is a growing health concern amongst all populations. The relationship between sleep apnea and heart health is also of particular interest in clinical populations. Thus, the aim of this study was to examine if OSA in cardiac patients leads to a higher prevalence of atrial fibrillation (AF).

Methods: Data was retrospectively analyzed from the Sleep Heart Health Study (SHHS). Patients with cardiovascular disease were divided into an OSA group or a control group who did not have OSA. Demographic and descriptive statistics were completed on all subjects and a chi-square analysis was used to determine prevalence among the groups. The alpha level was set at < 0.05 for significance.

Results: No statistically significant difference (p = .120) was seen in atrial fibrillation prevalence for cardiac patients with OSA (n = 271) compared to cardiac patients without OSA (n = 34).

Conclusion: Cardiac patients with OSA displayed a higher AF prevalence rate of 17.8% when compared with cardiac patients without OSA who had an AF prevalence rate of 13.8%. This difference was not calculated to be statistically significant although limitations unique to this study should be considered when interpreting data.

 Keywords: Obstructive Sleep Apnea; Atrial Fibrillation; Cardiac Patients; Prevalence

1. Abumuamar AM., et al. “The prevalence of obstructive sleep apnea in patients with atrial fibrillation”. Clinical Cardiology 5 (2018): 601-607.
2. Aldahasi MA., et al. “An overview on obstructive sleep apnea diagnosis and management in primary health care centre”. Journal of Biochemical Technology4 (2020): 93-97.
3. Alshehri AM. “Stroke in atrial fibrillation: Review of risk stratification and preventive therapy”. Journal of Family and Community Medicine 2 (2019): 92-97.
4. Baratta F., et al. “Severity of OSAS, CPAP and cardiovascular events: A follow-up study”. European Journal of Clinical Investigation 5 (2018): e12908.
5. Benjamin EJ., et al. “Heart disease and stroke statistics-2019 update: A report from the American heart association”. Circulation10 (2019): e56-e528.
6. Borsini E., et al. “Prevalence of sleep apnea and cardiovascular risk factors in patients with hypertension in a day hospital model”. Clinical and Experimental Hypertension 3 (2018): 231-237.
7. Cekerevac I., et al. “Impact of severity of obstructive sleep apnea (OSA) and body composition on redox status in OSA patients”. Vojnosanitetski Pregled11 (2018): 1089-1093.
8. Chugh SS., et al. “Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study”. Circulation 8 (2014): 837-847.
9. Dhakal SS., et al. “Prevalence of atrial fibrillation in obstructive sleep apnea patients in a tertiary care center”. Journal of Nepal Medical Association222 (2020): 80-83.
10. Dinç Y., et al. “Causes of ischemic stroke in patients with atrial fibrillation”. Turkish Journal of Neurology4 (2020): 311-315.
11. Erdogan A., et al. “Prevalence of atrial fibrillation in obstructive sleep apnea”. Somnologie-Schlafforschung und Schlafmedizin4 (2009): 211-214.
12. Franklin KA and Lindberg E. “Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea”. Journal of Thoracic Disease 8 (2015): 1311-1322.
13. Healey JS., et al. “Subclinical atrial fibrillation and the risk of stroke”. New England Journal of Medicine2 (2012): 120-129.
14. Heinzer R., et al. “Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study”. The Lancet Respiratory Medicine4 (2015): 310-318.
15. Hendrikx T., et al. “Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea”. PLoS One2 (2017): e0171575.
16. Hersi AS. “Obstructive sleep apnea and cardiac arrhythmias”. Annals of Thoracic Medicine 1 (2010): 10-17.
17. Kasai T., et al. “Sleep apnea and cardiovascular disease: a bidirectional relationship”. Circulation12 (2012): 1495-1510.
18. Latina JM., et al. “The relationship between obstructive sleep apnea and atrial fibrillation: a complex interplay”. Pulmonary Medicine (2013): 621736.
19. Miller JD., et al. “Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation”. Journal of the American College of Cardiology 25 (2015): 2899-2906.
20. Mohammad Y., et al. “Stroke during sleep and obstructive sleep apnea: there is a link”. Neurological Sciences 5 (2019): 1001-1005.
21. Peppard PE., et al. “Increased prevalence of sleep-disordered breathing in adults”. American Journal of Epidemiology 9 (2013): 1006-1014.
22. Quan SF., et al. “The sleep Heart health study: design, rationale, and methods”. Sleep12 (1997): 1077-1085.
23. Riaz S., et al. “The converging pathologies of obstructive sleep apnea and atrial arrhythmias”. Cureus 7 (2020): e9388.
24. Tietjens JR., et al. “Obstructive sleep apnea in cardiovascular disease: a review of the literature and proposed multidisciplinary clinical management strategy”. Journal of the American Heart Association 1 (2019): e010440.
25. Traaen GM., et al. “Prevalence, risk factors, and type of sleep apnea in patients with paroxysmal atrial fibrillation”. International Journal of Cardiology. Heart and Vasculature 26 (2020): 100447.
26. Watson NF. “Health care savings: The economic value of diagnostic and therapeutic care for obstructive sleep apnea”. Journal of Clinical Sleep Medicine 8 (2016): 1075-1077.
27. Wolf PA., et al. “Atrial fibrillation as an independent risk factor for stroke: the Framingham Study”. Stroke 8 (1991): 983-988.