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Obstructive sleep apnea severity and prevalent atrial fibrillation in a sleep clinic cohort with versus without excessive daytime sleepiness

Holtstrand Hjälm, Henrik ; Thunström, Erik ; Glantz, Helena ; Karlsson, Martin ; Celik, Yeliz and Peker, Yüksel LU (2023) In Sleep Medicine 112. p.63-69
Abstract

Background: Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF) in cardiac cohorts. Less is known regarding the magnitude of this association in a sleep clinic cohort with vs. without excessive daytime sleepiness (EDS). Objectives: To explore the association of OSA severity with AF in a sleep clinic cohort stratified by EDS. Patients and methods: All consecutive adults (n = 3814) admitted to the Skaraborg Hospital, Sweden between Jan 2005 and December 2011 were registered in a local database, and the follow-up ended in December 2018. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/h. Mild OSA was defined as AHI ≥5 & AHI<15 events/h; moderate OSA as AHI ≥15 & AHI<30 events/h; and severe OSA... (More)

Background: Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF) in cardiac cohorts. Less is known regarding the magnitude of this association in a sleep clinic cohort with vs. without excessive daytime sleepiness (EDS). Objectives: To explore the association of OSA severity with AF in a sleep clinic cohort stratified by EDS. Patients and methods: All consecutive adults (n = 3814) admitted to the Skaraborg Hospital, Sweden between Jan 2005 and December 2011 were registered in a local database, and the follow-up ended in December 2018. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/h. Mild OSA was defined as AHI ≥5 & AHI<15 events/h; moderate OSA as AHI ≥15 & AHI<30 events/h; and severe OSA as AHI ≥30 events/h. EDS was defined as an Epworth Sleepiness Scale score ≥11. We conducted cross-sectional analyzes of the prevalent AF across the OSA severity categories and logistic regression analyzes stratified by EDS. Results: In all, 202 patients (5.3%) had AF at baseline, 1.6% in no-OSA, 3.9% in mild OSA, 5.2% in moderate OSA, and 7.6% in severe OSA, respectively (p < 0.001). The stratified analyzes revealed that patients with severe OSA without EDS had an increased risk for prevalent AF (OR 2.54, 95% CI 1.05–6.16; p = 0.039) independent of the confounding factors. Conclusions: There was an independent dose-response relationship between OSA and prevalent AF among the non-sleepy phenotype in this sleep clinic cohort. Since adherence to OSA treatment is challenging in the absence of EDS, these patients may have increased risk for adverse cardiovascular outcomes.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Excessive sleepiness, Obstructive sleep apnea
in
Sleep Medicine
volume
112
pages
7 pages
publisher
Elsevier
external identifiers
  • pmid:37806037
  • scopus:85173142369
ISSN
1389-9457
DOI
10.1016/j.sleep.2023.09.012
language
English
LU publication?
yes
id
a90b04ec-fcfb-4d6e-b27e-9f6ca30f7612
date added to LUP
2023-11-30 14:16:30
date last changed
2024-04-27 17:15:09
@article{a90b04ec-fcfb-4d6e-b27e-9f6ca30f7612,
  abstract     = {{<p>Background: Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF) in cardiac cohorts. Less is known regarding the magnitude of this association in a sleep clinic cohort with vs. without excessive daytime sleepiness (EDS). Objectives: To explore the association of OSA severity with AF in a sleep clinic cohort stratified by EDS. Patients and methods: All consecutive adults (n = 3814) admitted to the Skaraborg Hospital, Sweden between Jan 2005 and December 2011 were registered in a local database, and the follow-up ended in December 2018. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/h. Mild OSA was defined as AHI ≥5 &amp; AHI&lt;15 events/h; moderate OSA as AHI ≥15 &amp; AHI&lt;30 events/h; and severe OSA as AHI ≥30 events/h. EDS was defined as an Epworth Sleepiness Scale score ≥11. We conducted cross-sectional analyzes of the prevalent AF across the OSA severity categories and logistic regression analyzes stratified by EDS. Results: In all, 202 patients (5.3%) had AF at baseline, 1.6% in no-OSA, 3.9% in mild OSA, 5.2% in moderate OSA, and 7.6% in severe OSA, respectively (p &lt; 0.001). The stratified analyzes revealed that patients with severe OSA without EDS had an increased risk for prevalent AF (OR 2.54, 95% CI 1.05–6.16; p = 0.039) independent of the confounding factors. Conclusions: There was an independent dose-response relationship between OSA and prevalent AF among the non-sleepy phenotype in this sleep clinic cohort. Since adherence to OSA treatment is challenging in the absence of EDS, these patients may have increased risk for adverse cardiovascular outcomes.</p>}},
  author       = {{Holtstrand Hjälm, Henrik and Thunström, Erik and Glantz, Helena and Karlsson, Martin and Celik, Yeliz and Peker, Yüksel}},
  issn         = {{1389-9457}},
  keywords     = {{Atrial fibrillation; Excessive sleepiness; Obstructive sleep apnea}},
  language     = {{eng}},
  pages        = {{63--69}},
  publisher    = {{Elsevier}},
  series       = {{Sleep Medicine}},
  title        = {{Obstructive sleep apnea severity and prevalent atrial fibrillation in a sleep clinic cohort with versus without excessive daytime sleepiness}},
  url          = {{http://dx.doi.org/10.1016/j.sleep.2023.09.012}},
  doi          = {{10.1016/j.sleep.2023.09.012}},
  volume       = {{112}},
  year         = {{2023}},
}