WASHINGTON – About 18% of U.S. patients with atrial fibrillation also have a diagnosis of obstructive sleep apnea, and the confluence of the two appeared linked to increased hospitalizations and further progression of atrial fibrillation, based on a registry of more than 10,000 U.S. atrial fibrillation patients.
In addition, patients who have AF and OSA and who are treated with continuous positive airway pressure (CPAP) have a reduced rate of AF progression, Dr. Jonathan P. Piccini Sr. said at the annual meeting of the American College of Cardiology.
"We probably are not screening for obstructive sleep apnea as aggressively as we should" in AF patients, said Dr. Piccini, an electrophysiologist at Duke University in Durham, N.C. "We know that if obstructive sleep apnea is treated [with CPAP,] the AF burden can be dramatically reduced."
Mitchel L. Zoler/Frontine Medical News
Dr. Jonathan P. Piccini
The data Dr. Piccini and his associates analyzed came from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), which starting in 2010 enrolled more than 10,000 AF patients from 172 U.S. locations with a variety of practice settings and followed them for more than 2 years. Their medical records showed that at enrollment, 1,841 of the 10,132 enrolled AF patients (18%) had also been diagnosed with OSA. Patients with OSA averaged 69 years old, while those without the disorder averaged 76 years old. Those with OSA had an average body mass index of 34 kg/m2, compared with 28 kg/m2 among those without OSA. Patients with OSA also had higher prevalence rates of dyspnea and fatigue than the enrolled AF patients without OSA.
During 2 years of follow-up, the two subgroups had similar rates of all-cause death, cardiovascular events, major bleeding events, and AF progression, but after multivariate adjustment, patients with OSA had a 12% higher rate of hospitalizations than did patients without OSA, a statistically significant difference.
Further analysis of the 1,624 OSA patients showed that 937 (58%) used CPAP during follow-up as a treatment for OSA. Comparison of the CPAP users and nonusers showed no significant difference in outcomes during follow-up for all-cause death, hospitalizations, cardiovascular events, or major bleeding events, but there was a statistically significant, 34% relative drop in the rate of AF progression among CPAP users compared with nonusers.
The ORBIT-AF registry is sponsored by Johnson & Johnson. Dr. Piccini has received remuneration from Johnson & Johnson, Forest Laboratories, and other companies.
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