Comparing Clinical Treatments and Outcomes of Patients with Atrial Fibrillation and Obstructive Sleep Apnea

TL;DR

This study shows that obstructive sleep apnea influences treatment strategies for atrial fibrillation, with OSA patients more likely to receive rate control therapy.

Contribution

The study is the first to explore how OSA affects AF management strategies and outcomes.

Findings

AF patients with OSA predominantly received rate control (75%) compared to rhythm control (12%).

AF patients without OSA predominantly used rhythm control (88.9%) over rate control (3.7%).

COPD and CHF were associated with significantly higher mortality in patients with both AF and OSA.

Abstract

Atrial fibrillation (AF) is a common arrhythmia that is bidirectionally associated with obstructive sleep apnea (OSA), where OSA increases the risk of AF onset and recurrence, while AF may exacerbate OSA symptoms through hemodynamic and autonomic mechanisms. Both conditions pose significant global public health concerns and increase cardiovascular risk. However, the effect of OSA on AF management strategy and outcome has not been explored previously. The purpose of our study was to evaluate clinical outcomes in patients with AF and OSA.

Our study included 130 patients over the age of 18 with AF, of which 100 patients were diagnosed with OSA. We evaluated multiple clinical outcomes including comorbidities, treatment strategies, vitals, end organ function, and mortality from June, 2021 to November, 2023 through retrospective chart review. Data was analyzed using chi-square, fisher’s exact test and logistic regression.

Results were significant for a predominance in rate control management strategy (12% rhythm control vs 75% rate control) used in AF with OSA and predominance in rhythm control management strategy (88.9% rhythm control vs 3.7% rate control) used in AF without OSA (p=0.0279). Evaluating mortality in patients with both AF and OSA, COPD (54.6% mortality) and CHF (78.8%) were associated with significantly higher mortality (p<0.0001). There was no significant mortality benefit between rate versus rhythm strategy overall in any patient with AF (OR 0.49, CI 0.153-1.570, p-value =0.229).

While rate and rhythm control strategies are used interchangeably in managing AF, our study emphasizes a role of OSA in determining rate versus rhythm management strategy for AF treatment. Thus, the presence or absence of underlying OSA may be used as a clinical decision-making factor in managing AF.