Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation
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Objectives This study sought to identify whether obesity and obstructive sleep apnea (OSA) independently predict incident atrial fibrillation/flutter (AF).Background Obesity is a risk factor for AF, and OSA is highly prevalent in obesity. Obstructive sleep apnea is associated with AF, but it is unknown whether OSA predicts new-onset AF independently of obesity.Methods We conducted a retrospective cohort study of 3,542 Olmsted County adults without past or current AF who were referred for an initial diagnostic polysomnogram from 1987 to 2003. New-onset AF was assessed and confirmed by electrocardiography during a mean follow-up of 4.7 years.Results Incident AF occurred in 133 subjects (cumulative probability 14%, 95% confidence interval [CI] 9% to 19%). Univariate predictors of AF were age, male gender, hypertension, coronary artery disease, heart failure, smoking, body mass index, OSA (hazard ratio 2.18, 95% CI 1.34 to 3.54) and multiple measures of OSA severity. In subjects <65 years old, independent predictors of incident AF were age, male gender, coronary artery disease, body mass index (per 1 kg/m2, hazard ratio 1.07, 95% CI 1.05 to 1.10), and the decrease in nocturnal oxygen saturation (per 0.5 U log change, hazard ratio 3.29, 95% CI 1.35 to 8.04). Heart failure, but neither obesity nor OSA, predicted incident AF in subjects > or =65 years of age.Conclusions Obesity and the magnitude of nocturnal oxygen desaturation, which is an important pathophysiological consequence of OSA, are independent risk factors for incident AF in individuals <65 years of age.
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An agent that raises the arousal threshold may cause substantial hypoxemia and hypercapnia that could affect end organ function.
“an agent which raises the arousal threshold may yield substantial hypoxemia and hypercapnia which could impact end organ function.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [414]
The Discussion says apnea causes hypoxemia that may contribute to cardiovascular complications. It does not address whether an agent that raises the arousal threshold causes substantial hypoxemia or hypercapnia; searches for those terms found no supporting passage. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn one retrospective PSG cohort, patients with AHI ≥5 were twice as likely to develop atrial fibrillation as those with AHI <5, an effect limited to those under age 65; after adjustment, mean nocturnal SaO2 but not AHI was an independent predictor of incident atrial fibrillation.
“In one, patients with AHI ≥ 5 were twice as likely to develop AF as those with AHI < 5, an effect that was limited to those under age 65; however, adjusting for age, sex, BMI, and prevalent CV disease, mean nocturnal SaO2 but not AHI was an independent predictor of incident AF.414”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [414]
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Experimental — accuracy not yet measuredObstructive sleep apnoea versus none is independently associated with AF (HR 2.18, 95% CI 1.34-3.54).
“Obstructive sleep apnoea vs. none 210 HR 2.18 (95% CI 1.34-3.54)”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [210]
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Self-citationMaston, G., Franklin, J., Hocking, S., Swinbourne, J., Gibson, A., Manson, E., Sainsbury, A., & Markovic, T. (2021) · PLOS ONE · doi:10.1371/journal.pone.0253127 · Cited by 14 · see citing works
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Self-citation
- Authors
- Gami, A. S., Hodge, D. O., Herges, R. M., Olson, E. J., Nykodym, J., Kara, T., & Somers, V. K.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Somers, Virend K.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-02
- Volume
- 49
- Issue
- 5
- Pages
- 565-571
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2032233607
- Cited by
- 1,104
- References
- 38
- Citations by year
- 2026: 32 · 2025: 30 · 2024: 65 · 2023: 49 · 2022: 74 · 2021: 60 · 2020: 78 · 2019: 59 · 2018: 90 · 2017: 66 · 2016: 66 · 2015: 67 · 2014: 60 · 2013: 67 · 2012: 64
- FWCI
- 29.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- ResMed
- National Institutes of Health (RR-00585)
- National Heart, Lung, and Blood Institute (HL65176, R01HL073211, R01HL065176, HL61560, HL73211, R01HL061560)
- National Center for Research Resources (M01-RR00 585, M01RR000585)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- obstructive sleep apnea, obesity, atrial fibrillation, incident atrial fibrillation, nocturnal hypoxemia, body mass index, risk factors, older adults, polysomnography, heart failure
- MeSH terms
- Adult, Age Factors, Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Obesity, Retrospective Studies, Risk Factors, Sex Factors, Cohort Studies, Incidence, Sleep Apnea, Obstructive
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