Impact of Sleep Apnea on Cardioembolic Risk in Patients With Atrial Fibrillation
Martino F. Pengo, Andrea Faini, Ludger Grote, Ondřej Ludka, Pavol Joppa, Athanasia Pataka, Zoran Đogaš, Ștefan Mihăicuță, Holger Hein, Ulla Anttalainen, Stephen J. Ryan, Carolina Lombardi, Gianfranco Parati, on behalf of the ESADA Working Group
Abstract
Background and Purpose: An accurate determination of the cardioembolic risk in patients with atrial fibrillation (AF) is crucial to prevent consequences like stroke. Obstructive sleep apnea (OSA) is a known risk factor for both AF and stroke. We aim to explore a possible association between OSA and an increased cardioembolic risk in patients with AF. Methods: We assessed data from the ESADA (European Sleep Apnea Database) cohort where patients with known AF and OSA were included. Parameters of OSA severity and related hypoxia like lowest Sp o 2 and 4% oxygen desaturation index were analyzed. Patients were stratified according to their cardioembolic risk estimated with the CHA 2 DS 2 -VASc score. Results: From the initial cohort of 14 646 patients, a final set of 363 patients were included in the analysis. Indices of hypoxia during sleep were associated with increased CHA 2 DS 2 -VASc score (4% oxygen desaturation index 17.9 versus 29.6 versus 30.5 events/hour and the lowest Sp o 2 81.2 versus 77.8 versus 77.5% for low, moderate, and high cardioembolic risk, respectively, P <0.05). Conclusions: These results support the potential role of OSA-related hypoxia in the risk for cardioembolic complications such as stroke in patients with AF.