Abstract
ObjectivesTo conducted a meta-analysis assessing the relationship between Obstructive Sleep Apnea (OSA) and the risk of Atrial Fibrillation (AF)MethodsWe searched PUBMED, Medline, and Cochrane Library using the keywords “atrial fibrillation”, “obstructive sleep apnea” and “sleep disordered breathing (SDB)”. All subjects included had established diagnosis of OSA/SDB. We then compared the occurrence of AF versus no AF. Analysis done with Comprehensive Meta-Analysis package V3 (Biostat, USA).ResultsA total of 579 results were generated. Duplicates were removed and 372 records were excluded based on irrelevant abstracts, titles, study design not consistent with the stated outcome, or full-text unavailable. Twelve studies meeting the inclusion criteria were reviewed in full-text; 2 of these articles were eventually removed due to unconfirmed OSA diagnostic modality, and one was also removed based on a control group inconsistent with the other studies. Therefore, a total of 9 studies were included (n=19,837). Sample sizes ranged from n=160 patients to n=6841 patients. The risk of AF was found to be higher among OSA/SDB versus control group (OR; 2.120, C.I: 1.845–2.436, Z; 10.598 p: <0.001). The heterogeneity observed for the pooled analysis was Q-value; 22.487 df (Q); 8 P-value; 0.004, I-squared; 64.424 Tau2; 0.098, suggesting appropriate study selection and moderate heterogeneity.ConclusionOSA/SDB is strongly associated with AFib confirming the notion that OSA/SDB populations are high risk for development of AF. Prospective studies are needed to ascertain the effect of the treatment of OSA/SDB for the prevention of AF, a growing health burden with serious consequences.
Highlights
Atrial Fibrillation (AF) is a growing health problem worldwide, estimated to affect 5.6 million to 15.9 million people in the United States by 2050 [1]
We aim to extend prior work explaining the relationship between Obstructive Sleep Apnea (OSA) and AF by performing a comprehensive meta-analysis reporting the association between OSA and AF
Studies included in our meta-analysis provided odds-ratio or relative-risk values with 95% confidence intervals (CIs)
Summary
AF is a growing health problem worldwide, estimated to affect 5.6 million to 15.9 million people in the United States by 2050 [1]. It is associated with an increased risk for morbidity and mortality [2], Modifiable risk factors for AF have been delineated, and include hypertension, obesity and alcohol consumption [3]. As the incidence of AF continues to rise, it is imperative to identify and treat potentially modifiable risk factors for the disease. OSA is generally underdiagnosed medical problem, estimated to affect as many as 1 in 5 adults with the incidence on the rise as the obesity epidemic continues to grow [4]. There have been several proposed hypothesis as well as animal models attempting to clarify the role of the underlying pathophysiological mechanisms of OSA on the genesis of AF; there are little or no controlled studies of all relevant available data, showing a direct impact of OSA on the incidence of AF
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