Obstructive sleep apnea (OSA) was found to be an independent risk factor for major adverse cardiac and neurologic events (MACNE) in patients with atrial fibrillation (AF), according to a study published in the American Heart Journal.

In this retrospective cohort study, a total of 22,760 patients who participated in the ORBIT-AF I and II (ClinicalTrials.gov Identifiers: NCT01165710 and NCT01701817, respectively) trials were included (n=4045 with AF and OSA; n=18,715 with AF and without OSA). The occurrence of MACNE, a composite of cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non-central nervous system embolism, and new-onset heart failure, was the study’s primary outcome. Individual components of MACNE constituted secondary outcomes.

Patients with vs without OSA were younger (median, 68 years vs 74 years, respectively; P <.0001), more likely to be men (70.7% vs 55.3%, respectively; P <.0001), and had higher body mass index (median, 34.6 kg/m2 vs 28.7 kg/m2, respectively; P <.0001). During a median follow-up period of 1.5 years, 1895 patients experienced a MACNE. Participants with vs without OSA had a greater risk of MACNE (hazard ratio [HR], 1.16; 95% CI, 1.03-1.31; P =.011). The presence of OSA was found to be an independent risk factor for stroke/ transient ischemic attack/non-central nervous system embolism (HR, 1.38; 95% CI, 1.12-1.70; P =.003). No association between OSA and the other MACNE components was identified.

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Limitations of the study include its observational and retrospective nature and the possibility that some participants may not have been identified as having OSA.

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 “[O]ur results suggest that OSA confers incremental and independent residual risk for adverse cardiovascular and neurologic outcomes,” concluded the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Dalgaard F, North MRR, Pieper K, et al. Risk of major cardiovascular and neurologic events with obstructive sleep apnea among patients with atrial fibrillation [published online January 7, 2020]. Am Heart J. doi: 10.1016/j.ahj.2020.01.001