Atrial fibrillation is associated with central sleep apnea in clinic patients undergoing diagnostic polysomnography

Abstract

Introduction Sleep apnea is highly prevalent in patients with atrial fibrillation (AF). Obstructive sleep apnea (OSA) is the most common type, and best studied in the context of AF. However, recent investigations have indicated that central sleep apnea (CSA) may be a risk factor for incident AF. We evaluated the burden of CSA events in patients referred for diagnostic polysomnography (PSG) and whether AF is associated with CSA. Methods We identified patients with and without a history of AF who underwent clinically indicated PSG in a matched manner. OSA was defined as obstructive apnea‐hypopnea index (AHI) ≥15/h, and CSA was defined as central apnea index (CAI) ≥5/h. The association between AF and CSA was evaluated using multivariable logistic regression. Results Among 465 patients included, mean AHI was 25.5/h, and mean CAI was 1.7/h. OSA prevalence was 53.3%, while CSA prevalence was 8.4%. The prevalence of OSA in the AF and non‐AF groups (54.7% vs 52.0%, P = .56) was similar. CSA was more common in the AF group (12.3% vs 4.4%, P = .002). In multivariable analysis, AF (OR: 2.19 [1.02, 5.03], P = .05), male gender (OR: 2.5 [1.17, 5.84], P = .02), and older age (OR: 2.44, [1.16, 5.46], P = .02) were associated with CSA. Conclusion Though CSA is much less common than OSA in patients with AF, the presence of AF is independently associated with CSA.

Central Sleep Apnea in Patients With Coronary Heart Disease Taking P2Y12 Inhibitors

“…As AF has also been noted to be associated with CSA, we performed a sensitivity analysis by additionally adjusting for AF to explore this relationship. 16,26,27 In this analysis, which additionally corrected for any AF history, ticagrelor (vs. clopidogrel) became more strongly associated with high CSA burden and became significantly associated with strict CSA (Tables 4 and 5). We did not exclude patients with a history of AF in our primary analysis because the event rate for CSA in our cohort is small, and excluding patients with a history of AF (32.5% of our cohort) would have further lowered the power of our study, as reflected by the large confidence interval.…”

“…Because of the reported association of atrial fibrillation (AF) with CSA, we performed analysis additionally adjusting for any history of AF. 16,17 Similarly, an additional subgroup analysis was performed on only patients with ACS due to the high reported prevalence of sleep-disordered breathing in patients with ACS. Statistical analysis was performed through R with gtsummary package.…”

Sleep apnea severity in patients undergoing atrial fibrillation ablation: Home sleep apnea‐test and polysomnography comparison

“…1,2 SA is highly prevalent in AF patients because of the linking mechanisms between SA and AF including activation of the sympathetic nervous system during intermittent hypoxia and structural remodeling of the left atrium through the negative intrathoracic pressure during an obstructive apnea episode. 3,4 Experimental, epidemiological, and clinical studies have consistently shown that SA is a potential risk factor for the incidence and recurrence of AF. 5 A meta-analysis reported that obstructive SA (OSA) is associated with a 31% greater risk of AF recurrence after catheter ablation (CA) of AF.…”

“…Atrial fibrillation (AF) and sleep apnea (SA) are common, and both have a risk of cardiovascular morbidity and mortality 1,2 . SA is highly prevalent in AF patients because of the linking mechanisms between SA and AF including activation of the sympathetic nervous system during intermittent hypoxia and structural remodeling of the left atrium through the negative intrathoracic pressure during an obstructive apnea episode 3,4 …”

Management of Obstructive Sleep Apnea in Patients With Heart Failure

“…The presence of CSA appears to have adverse prognostic implications (21,22). It is important to note that HF results from coexisting OSA and CSA, or complex sleep apnea syndrome (23). However, patients have little understanding of coexistence.…”