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Association of overlap syndrome with incident atrial fibrillation

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Abstract

Increasingly compelling data link chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) to cardiovascular complications independent of known comorbidities. It remains unclear whether the association is amplified in the presence of both conditions. The aims of this study are to assess the prevalence of atrial fibrillation (AF) in overlap syndrome (OS) and to identify risk factors predisposing to this atrial arrhythmia. We conducted a retrospective cohort study of 268 adults without past or current AF who were referred for an initial diagnostic polysomnogram from 2012 to 2019. A logistic regression analysis was performed to identify risk factors for incident AF. Incident AF occurred in 64 subjects [cumulative probability 24%, 95% confidence interval (CI) 19–29]. Independent predictors of incident AF were age-adjusted Charlson index [Odds ratio (OR) 1.62; 95% confidence interval (CI) 1.3–2.0], percentage of time spent with O2 saturation below 90% (CT90) (OR 3.72, 95% CI 1.18–11.71), and CPAP adherence (OR 0.32, 95% CI 0.13–0.71). OS patients with AF experienced higher hospitalization rates (OR 1.25, 95% CI 1.03–2.37) and worse mortality rates (OR 1.92, 95% CI 1.04–3.54). In multivariate Cox proportional regression, age-adjusted Charlson Index, severity of airflow obstruction, and CPAP adherence were independent predictors of mortality. The burden of hypoxemia and severity of comorbidities are independent factors for incident AF in individuals with OS. CPAP adherence may mitigate the risk of AF and reduce the rate of mortality in this population.

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Authors and Affiliations

  1. The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA

    Morohunfolu Akinnusi, Abdul Rahman El-Masri, Yolanda Lawson & Ali Albert El-Solh

  2. Department of Medicine, Jacob’s School of Medicine, Buffalo, NY, USA

    Ali Albert El-Solh

  3. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA

    Ali Albert El-Solh

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  1. Morohunfolu Akinnusi
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Contributions

The contribution of co-authors involved any one of the following: study conception and design, interpretation of data, revising the dataset creation plan and the manuscript critically for the accuracy and important intellectual content, and final approval of the version of the manuscript. ARE and YL were involved in the following: literature search, obtaining administrative data, and analyses of data. YL additionally was involved in the applications for the ethics board and obtaining administrative data. MA and AES were involved in drafting of the manuscript.

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Correspondence to Ali Albert El-Solh.

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MA declares that he has no conflict; ARE declares that he has no conflict of interest; YL declares that she has no conflict of interest; AES has received funding from the US Department of Veterans Affairs.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was deemed exempt by the Institutional Review Board.

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This is a retrospective study that include anonymized patients extracted from hospital database; data are presented aggregated and anonymously. No informed consent was taken.

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Akinnusi, M., El-Masri, A.R., Lawson, Y. et al. Association of overlap syndrome with incident atrial fibrillation. Intern Emerg Med 16, 633–642 (2021). https://doi.org/10.1007/s11739-020-02469-y

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