Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study

Abstract

Numerous reports have been done to seek the relationship between sleep apnea hypopnea syndrome (SAHS) and the risk of atrial fibrillation (AF). However, definite conclusion has not yet been fully established. We examined whether SAHS increases AF incidence in common population and summarized all existing studies in a meta-analysis. We summarized the current studies by searching related database for potential papers of the association between SAHS and the risk of AF. Studies that reported original data or relative risks (RRs) with 95% confidence intervals (CIs) for the associations were included. Sensitivity analyses were performed by omitting each study iteratively and publication bias was detected by Begg's tests. Eight eligible studies met the inclusion criteria. Fixed effects meta-analysis showed that SAHS increased AF risk in the common population (RR = 1.70, 95% CI: 1.53–1.89, P = 0.002, I2 = 69.2%). There was a significant association between mild SAHS and the risk of AF (RR = 1.52, 95% CI: 1.28–1.79, P = 0.01, I2 = 78.4%), moderate SAHS (RR = 1.88, 95% CI: 1.55–2.27, P = 0.017, I2 = 75.6%), and severe SAHS (RR = 2.16, 95% CI: 1.78–2.62, P < 0.001, I2 = 91.0%). The results suggest that sleep apnea hypopnea syndrome could increase the risk of AF, and the higher the severity of SAHS, the higher risk of atrial fibrillation.

Cardiovascular manifestations in obstructive sleep apnea: current evidence and potential mechanisms

“…The presence of OSA increases the risk of developing AF with a relative risk of 1.7, as found by a recent meta -analysis. 61 Multiple observational studies have suggested that CPAP treatment may lower the rate of AF recurrence following electrical cardioversion, 58 though data from RCTs are lacking. Interestingly, symptomatology characteristic of OSA is less predictive in this population than in the general OSA population.…”

The epidemiology of obstructive sleep apnoea and cardiovascular disease

“…A recent meta-analysis of 8 cohort studies showed that the presence of OSA increases the risk of developing AF with a RR of 1.70 (95% CI, 1.53-1.89) (46). This appeared to occur in a dose dependent fashion: RR 1.52 (95% CI, 1.28-1.…”

“…This appeared to occur in a dose dependent fashion: RR 1.52 (95% CI, 1.28-1. (46). In a retrospective cohort study of 3,452 adults who had sleep studies, independent predictors of incident AF in subjects <65 years were known risk factors such as age, male gender, CAD and BMI but also the presence of nocturnal hypoxia, the latter increasing the risk of incident AF threefold after correcting for obesity (47).…”

Atrial fibrillation: A review of modifiable risk factors and preventive strategies

“…In most of the conducted studies, a significant association has been observed between sleep disorders and AF risk (RR range of 1.26-2.51) [85]. A recent meta-analysis reported that sleep disorders increased the risk of AF significantly (RR = 1.70), and higher severity of sleep disorders was associated with a higher AF risk [86]. Moreover, another meta-analysis confirmed that the risk of AF was greater among patients with sleep disorders compared with the control group OR (Olds ratio) = 2.1 [87].…”