Obstructive Sleep Apnea May Be a Risk Factor for MACNE in Atrial Fibrillation

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.

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

 “[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.

Reference

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