In patients with obstructive sleep apnea (OSA), undiagnosed atrial fibrillation (AF) and untreated cardiovascular (CV) modifiable risk factors are common, according to the results of a prospective, observational study published in the journal Sleep Medicine.
Researchers sought to explore the prevalence of silent AF and associated risk factors in patients evaluated for OSA or those with known OSA. The current analysis was conducted in 2 sites — Zealand University Hospital in Denmark and 1 private ear, nose, and throat clinic in Slagelse, Denmark. Patients were assessed for OSA with the use of a type-3 portable sleep monitoring device. Heart rhythm was monitored at home for 7 days with use of an event-triggered loop recorder. All participants were divided into groups of mild, moderate, and severe OSA, according to the Apnea-Hypopnea Index (AHI).
The researchers found that in a cohort of 303 individuals, 78.5% (238 of 303) of them were diagnosed with moderate or severe OSA and 21.5% (65 of 303) of them with no or mild OSA, with the latter individuals comprising the control group. Among the 238 participants with moderate or severe OSA, AF was detected in 8.8% (21 of 238) of them, compared with 1.5% (1 of 65) of participants with mild OSA (P =.045).
Candidates for anticoagulation treatment were referred for additional CV therapy. The majority of patients had known hypertension (66%) and dyslipidemia (77.6%). In those individuals with moderate or severe OSA, (ie, AHI ≥15), hypertension was significantly more dysregulated (P =.005) and more patients had prediabetes (P <.001).
Limitations of the study include the lack of use of a polysomnography for evaluation of OSA. Additionally, the researchers did not utilize Holter monitoring.
“We believe our study supports the alignment of the systematic screening and management of potential comorbidities associated with OSA, especially silent AF, prediabetes and diabetes, hypertension and hyperlipidaemia, to the benefit of OSA patients in the future,” the researchers acknowledged.
They concluded, “We propose that long-period home-monitoring in these patients is useful for identifying candidates for preventive anticoagulation, cardiovascular treatment and possibly prevent future ischemic stroke.”
Højager A, Schoos MM, Tingsgaard PK, Bock TG, Homøe P. Prevalence of silent atrial fibrillation and cardiovascular disease in patients with obstructive sleep apnea. Sleep Med. 2022;100:534-541. doi:10.1016/j.sleep.2022.10.002