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J Am Coll Cardiol, 2007; 49:565-571, doi:10.1016/j.jacc.2006.08.060 (Published online 19 January 2007).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ATRIAL FIBRILLATION

Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation

Apoor S. Gami, MD*,{dagger}, Dave O. Hodge, MS{ddagger}, Regina M. Herges, BS{ddagger}, Eric J. Olson, MD{dagger},§, Jiri Nykodym, BS*,{dagger}, Tomas Kara, MD*,{dagger} and Virend K. Somers, MD, PhD, FACC*,{dagger},||,1,*

* Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
{dagger} Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
{ddagger} Department of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
§ Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
|| Division of Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota

Manuscript received March 30, 2006; revised manuscript received August 22, 2006, accepted August 28, 2006.

* Reprint requests and correspondence: Dr. Virend K. Somers, 200 First Street SW, Rochester, Minnesota 55905. (Email: somers.virend{at}mayo.edu).

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 ≥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.

Abbreviations and Acronyms
  AF = atrial fibrillation/flutter
  CI = confidence interval
  HR = hazard ratio
  OSA = obstructive sleep apnea




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