Risk of major cardiovascular and neurologic events with obstructive sleep apnea among patients with atrial fibrillation

Autor: Rebecca North, Bernard J. Gersh, Gregg C. Fonarow, Karen S. Pieper, Daniel E. Singer, James A. Reiffel, Kenneth W. Mahaffey, Sean D. Pokorney, Peter R. Kowey, Michael D. Ezekowitz, Benjamin A. Steinberg, Paul Chan, Gerald V. Naccarrelli, Eric D. Peterson, Frederik Dalgaard, Jonathan P. Piccini, Larry A. Allen
Rok vydání: 2020
Předmět:
Male
Cardiorespiratory Medicine and Haematology
030204 cardiovascular system & hematology
Cardiovascular
Cohort Studies
0302 clinical medicine
Interquartile range
Atrial Fibrillation
80 and over
030212 general & internal medicine
Myocardial infarction
Lung
Stroke
Aged
80 and over
Sleep Apnea
Obstructive
screening and diagnosis
Sleep apnea
Atrial fibrillation
Middle Aged
Detection
Heart Disease
Cardiovascular Diseases
Public Health and Health Services
Cardiology
Female
Patient Safety
Sleep Research
Cardiology and Cardiovascular Medicine
4.2 Evaluation of markers and technologies
medicine.medical_specialty
Sleep Apnea
Risk Assessment
Article
03 medical and health sciences
Clinical Research
Internal medicine
medicine
Humans
Risk factor
Retrospective Studies
Aged
Obstructive
business.industry
Prevention
medicine.disease
Brain Disorders
Obstructive sleep apnea
Good Health and Well Being
Cardiovascular System & Hematology
Heart failure
Nervous System Diseases
business
Zdroj: Am Heart J
ISSN: 0002-8703
Popis: Background Obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF). However, it remains unclear whether OSA is independently associated with worse cardiovascular and neurological outcomes in patients with AF. Methods We used the ORBIT-AF I and ORBIT-AF II to conduct a retrospective cohort study of 22,760 patients with AF with and without OSA. Adjusted multivariable Cox proportional hazards models was used to determine whether OSA was associated with increased risk for major adverse cardiac and neurologic events (MACNEs) (cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non–central nervous system embolism (stroke/SE), and new-onset heart failure], combined and individually. Results A total of 4,045 (17.8%) patients had OSA at baseline. Median follow-up time was 1.5 (interquartile range: 1-2.2) years, and 1,895 patients experienced a MACNE. OSA patients were younger (median [interquartile range] 68 [61-75] years vs 74 [66-81] years), were more likely male (70.7% vs 55.3%), and had increased body mass index (median 34.6 kg/m2 [29.8-40.2] vs 28.7 kg/m2 [25.2-33.0]). Those with OSA had a higher prevalence of concomitant comorbidities such as diabetes, chronic obstructive pulmonary disease, and heart failure. OSA patients had higher use of antithrombotic therapy. After adjustment, the presence of OSA was significantly associated with MACNE (hazard ratio: 1.16 [95% CI: 1.03-1.31], P = .011). OSA was also an independent risk factor for stroke/SE beyond the CHA2DS2-VASc risk factors (HR: 1.38 [95% CI 1.12-1.70], P = .003) but not cardiovascular death, myocardial infarction, new-onset heart failure, or major bleeding. Conclusions Among patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.
Databáze: OpenAIRE
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