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Original Research: Sleep Disorders |

Severity of OSA Is an Independent Predictor of Incident Atrial Fibrillation Hospitalization in a Large Sleep-Clinic CohortOSA Predicts Incident Atrial Fibrillation

Gemma Cadby, PhD; Nigel McArdle, MD; Tom Briffa, PhD; David R. Hillman, MBBS; Laila Simpson, PhD; Matthew Knuiman, PhD; Joseph Hung, MBBS (Hons)
Author and Funding Information

From the Centre for Genetic Origins of Health and Disease (Drs Cadby and Simpson), the School of Anatomy, Physiology and Human Biology (Drs McArdle, Hillman, and Simpson), the School of Population Health (Drs Briffa and Knuiman), and the School of Medicine and Pharmacology (Dr Hung), Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley; and the West Australian Sleep Disorders Research Institute (Drs McArdle, Hillman, and Simpson), Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.

CORRESPONDENCE TO: Nigel McArdle, MD, West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia 6009; e-mail: nigel.mcardle@uwa.edu.au


Drs Cadby and McArdle contributed equally to this manuscript.

FUNDING/SUPPORT: The study was supported by the National Health and Medical Research Council project [Grant 1020373] and a Ray Florence Shaw Award [2013/14-001].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):945-952. doi:10.1378/chest.15-0229
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BACKGROUND:  OSA is a common condition that has been associated with atrial fibrillation (AF), but there is a paucity of data from large longitudinal cohorts to establish whether OSA is a risk factor for AF independent of obesity and other established risk factors.

METHODS:  We studied patients attending a sleep clinic referred for in-laboratory polysomnography for possible OSA between 1989 and 2001. Whole-population hospital data in Western Australia for 1970 to 2009 were linked to sleep study cases to determine incident AF hospitalization to 2009. Cox regression analyses were used to assess the independent association of OSA with incident AF.

RESULTS:  Study case subjects (6,841) were predominantly middle aged (48.3 ± 12.5 years old) and men (77%), and 455 developed AF during a median 11.9 years of follow-up. Univariate predictors of AF included age, BMI, hypertension, diabetes, valvular heart disease, coronary or peripheral artery disease, heart failure, and COPD (all P < .001). After multivariable adjustment, independent predictors of incident AF were an apnea/hypopnea index (AHI) > 5/h (hazard ratio [HR], 1.55; 95% CI, 1.21-2.00), log (AHI + 1) (HR, 1.15; 95% CI, 1.06-1.26), and log (time with oxygen saturation < 90% + 1) (HR, 1.12; 95% CI, 1.06-1.19). There were no interactions between age, sex, or BMI and AHI for AF development.

CONCLUSIONS:  OSA diagnosis and severity are independently associated with incident AF. Clinical trials are required to determine if treatment of OSA will reduce the burden of AF.

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