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 |
Externí odkaz: |