Obstructive sleep apnea and atrial fibrillation: insights from a bidirectional Mendelian randomization study

Abstract

Background Observational studies have suggested that obstructive sleep apnea (OSA) is in relation to atrial fibrillation (AF); however, these studies might be confounded and whether the relationship is causal remains unclear. We conducted a bidirectional Mendelian randomization (MR) study to clarify the causal inference between OSA and AF. Methods Genetic instruments for OSA and AF were obtained from genome-wide association studies. The fixed-effects inverse-variance weighted (IVW) method was used as the main method, supplemented by several sensitivity analyses. For replication, another AF dataset was used to validate the causal effect of OSA on AF. Furthermore, multivariable MR analyses were performed to obtain direct estimates adjusting for potential confounders. Results Genetic liability to OSA was found to be significantly associated with a higher AF risk in the fixed-effects IVW method [odds ratio (OR) 1.210; 95% CI 1.119–1.307; P = 1.51 × 10–6]. The results were consistent in MR sensitivity analyses as well as in replication analyses, and the significance remained after adjusting for potential confounders. In the reverse MR analyses, there was no causal effect of AF on OSA. Conclusions Our study strengthened the causal evidence of genetically predicted OSA with a higher AF risk. Early screening and appropriate management of OSA might show anti-arrhythmic benefits.

Circulating metabolites and depression: a bidirectional Mendelian randomization

“…On the basis of publicly available GWAS, summary-level data were acquired (Chen L. et al, 2022). Data on circulating metabolites provided by GWAS were carried out by the University of Oulu (Kettunen et al, 2016), and the data on depression provided by GWAS were primarily performed by the University of Edinburgh (Howard et al, 2018).…”

“…On the basis of the GWAS summary statistics, the effect estimates and corresponding standard errors (SE) of these SNPs of circulating metabolites and depression were acquired. The data for exposure (circulating metabolites) and outcome (depression) were harmonized, and palindromic SNPs were removed (Chen L. et al, 2022). Using simex package in R software and the formula…”

“…No significantly weak instrumental bias (Li et al, 2022) was observed when the F-statistic was >10. The inverse-variance weighted (IVW) model was applied as the major statistical method (Chen L. et al, 2022). Using sensitivity analyses, such as the weighted median, MR-Egger (Wang et al, 2022), and MR-pleiotropy residual sum and outlier (MR-PRESSO) (Verbanck et al, 2018;Yang et al, 2020), the possible pleiotropy was examined.…”

The problem of association between obstructive sleep apnea and atrial fibrillation in cardiology practice

“…Недавно опубликованная работа L. Chen и соавт. (2022), в которой использовались инструменты менделевского генетического анализа, также подтверждает причинно-следственные связи генетически предсказуемого ОАС с более высоким риском ФП [25]. Показательными являются данные группы G. Traaen и соавт.…”

Conversion of Atrial Fibrillation to Normal Sinus Rhythm With Optimal Continuous Positive Airway Pressure Therapy in Severe Obstructive Sleep Apnea

“…Recent studies have suggested that OSA promotes AF through structural and electrical atrial remodeling. 2 A recent meta-analysis showed that continuous positive airway pressure (CPAP) therapy reduces AF recurrence risk by 42% in patients with OSA. 3 However, whether CPAP can prevent AF or convert AF to normal sinus rhythm remains controversial.…”