Chest. 2026 Mar 5:S0012-3692(26)00269-2. doi: 10.1016/j.chest.2026.01.027. Online ahead of print.
ABSTRACT
BACKGROUND: Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF), but this association varies by population and definitions of OSA and AF.
RESEARCH QUESTION: Whether 'high cardiovascular disease risk' (High-CVD-Risk) OSA, defined by elevated hypoxic burden (HB) or heart rate response to respiratory events (ΔHR), is associated with incident AF.
STUDY DESIGN AND METHODS: Using data from the Multi-Ethnic Study of Atherosclerosis, HB was quantified as the cumulative area under the desaturation curve following respiratory events, and ΔHR as the increase in heart rate upon event termination. Within OSA (apnea-hypopnea index (AHI) ≥15 events/h), High-CVD-Risk OSA was defined as having either a high ΔHR or high HB (both in highest tertile), while individuals with OSA who did not meet these criteria were considered as Low-CVD-Risk. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) of incident AF for High- and Low-CVD-Risk OSA (vs Non-OSA, defined as an AHI < 15 events/h) after adjusting for confounders.
RESULTS: A total of 1,679 participants (45.4% male) were included, with a median [interquartile range] age of 66.0 [60.0-74.0] years, HB of 35.3 [18.0-69.2] %min/h, and ΔHR of 7.7 [5.9-9.9] bpm. During a median follow-up of 6.7 years, AF was identified in 14.1% of the High-CVD-Risk OSA (n = 687), 10.1% of the Low-CVD-Risk OSA (n = 278), and 8.4% of the Non-OSA (n = 714). Compared to the Non-OSA, an increased hazard ratio for AF was found in High-CVD-Risk OSA (HR, 1.68; 95% CI,1.17-2.41) but not in Low-CVD-Risk OSA (HR, 1.20; 95% CI, 0.76-1.92). The adjusted hazard ratio was similar in women and men ([HR, 1.71; 95% CI, 1.01-2.91] vs [HR, 1.64; 95% CI, 0.99-2.72]).
INTERPRETATION: OSA-related hypoxemia or heart rate surge may be useful for predicting which patients with OSA are at increased risk for incident AF.
PMID:41794120 | DOI:10.1016/j.chest.2026.01.027