Abstract 18192: Sleep Apnea and Incident Atrial Fibrillation : Implications for Targeted Screening

Abstract

Introduction: In younger individuals, the factors contributing to atrial fibrillation (AF) and ischemic stroke are not entirely understood. Despite the frequent coexistence of obstructive sleep apnea (OSA) and AF, current guidelines do not advise routine screening for either condition. Hypothesis: OSA may be an independent predictor of AF in younger adults Methods: We mined electronic health records of patients aged 20-50 Y who have had >=2 visits within Stanford Healthcare System during the period of 2008 to 2022. Our primary endpoint was incident AF. A comprehensive list of risk factors was mined as covariates. Time-varying covariate survival analysis was done to relate the covariates to the primary endpoint. Analysis was performed in R. Results: From a total population of approximately 1.3 million patients aged between 20 and 50 years, we identified 541168 individuals. Among them, 66088 (12.2%) had OSA. During the follow-up, 5060 young adults (67 per 100,000 person-years) developed new AF. In the multivariable adjusted time-varying analysis, apart from previously reported cardiovascular and demographic risk factors, sleep apnea [aHR:1.13 (1.06,1.20)], CKD [aHR:1.91 (1.22,1.44)], cancer [aHR:1.12, (1.04,1.20)], chronic liver disease [aHR:1.13, (1.05,1.21)] were independent risk factors of AF (Fig 1a). Although risk portended by sleep apnea may be slightly lower than some CHADS2VASC factors, sleep apnea is much more prevalent than them, which may support the benefit for screening in this young population (Fig 1b). Conclusions: In a cohort of over half a million adults aged between 20 and 50, sleep apnea significantly and independently predicts incident AF, which may have implications in screening and treatment strategies for younger patients.