0869 Non-Alcoholic Fatty Liver Disease is Associated with Worse Outcomes in Atrial Fibrillation patients with Obstructive Sleep Apnea

Autor: Amr Aboelnasr, Leonid Khokhlov, Guillermo Asmar Vargas, Usha Thapa, Mohammad Amin Eshaghabadi, Ahmed Abdelhaleem, Mohamad El Labban
Rok vydání: 2023
Předmět:
Zdroj: SLEEP. 46:A383-A383
ISSN: 1550-9109
0161-8105
DOI: 10.1093/sleep/zsad077.0869
Popis: Introduction Managing atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA) is challenging and often associated with worse outcomes. Non-alcoholic fatty liver disease (NAFLD) is shown to be associated with increased cardiovascular morbidity and mortality. The effect of NAFLD on AF in patients with OSA is not well studied. This study aims to investigate this association in hospitalized patients. Methods We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were cardiogenic shock, gastrointestinal bleeding (GIB), cardiac arrest, invasive mechanical ventilation (IMV) and length of stay (LOS). Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. Outcomes were adjusted for age, gender, race, heart failure, diabetes, CKD, chronic respiratory failure, stroke and history of MI. P-value < 0.05 was statistically significant. Results We identified 1,843,865 hospitalizations for AF with history of OSA: NAFLD in 61,235 (3.4%). AF with OSA and NAFLD vs. no NAFLD had mean age 68.4 vs. 70.6, males 65.2% vs. 64.1%, white 78.2% vs. 80.2%, black 9.3% vs. 10.2%, obesity 45.7% vs. 46.5%, heart failure 69.2% vs. 59.6%, diabetes 59.2% vs. 51.1%, anemia 23.5% vs. 17.2%, CKD 52.4% vs. 40% and COPD 38.2% vs. 39.1%. In-hospital mortality was 11.4% in the NAFLD group vs. 2.5% in the non-NAFLD group (aOR 5.2, P< 0.001). NAFLD vs. non-NAFLD groups had GIB 9.4% vs. 4.5% (aOR 2.1, P< 0.001), cardiac arrest 3.4% vs. 0.9% (aOR 3.4, P< 0.001), cardiogenic shock 7% vs. 1.2% (aOR 4.9, P< 0.001), IMV 10.9% vs. 3.4% (aOR 3.3, P< 0.001) and LOS 7.7 vs. 5.6 (aIRR 1.27, P< 0.001). Conclusion Our study shows that NAFLD has worsened the outcomes of patients admitted with AF and has history of OSA. The fivefold increase in in-hospital mortality is likely related to the increase in in-hospital hemorrhagic events and cardiac arrest. Clinicians should be aware of this association. Further research is needed to mitigate the detrimental effect of liver disease on OSA and AF patients. Support (if any)
Databáze: OpenAIRE
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