ArticleChest2026
Association of a High Cardiovascular Disease Risk OSA Phenotype With Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis.
Article in Chest, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOSA is associated with atrial fibrillation (AF), but this association varies by population and definitions of OSA and AF. RESEARCH QUESTION: Is high cardiovascular disease risk (High-CVD-Risk) OSA, defined by elevated hypoxic burden (HB) or heart rate response to respiratory events (ΔHR), associated with incident AF? STUDY DESIGN AND
methodsUsing data from the Multi-Ethnic Study of Atherosclerosis, HB was quantified as the cumulative area under the desaturation curve after respiratory events, and ΔHR was quantified as the increase in heart rate on event termination. Within OSA (apnea-hypopnea index [AHI] ≥15 events/h), High-CVD-Risk OSA was defined as having either a high ΔHR or high HB (both in the highest tertile), whereas individuals with OSA who did not meet these criteria were considered to have low cardiovascular disease risk (Low-CVD-Risk). Cox proportional hazards models were used to estimate the adjusted hazard ratios of incident AF for High-CVD-Risk OSA and Low-CVD-Risk OSA (vs non-OSA, defined as AHI < 15 events/h) after adjusting for confounders.
resultsA total of 1,679 participants (45.4% male) were included, with a median age of 66.0 years (interquartile range [IQR], 60.0-74.0 years), HB of 35.3%min/h (IQR, 18.0-69.2%min/h), and ΔHR of 7.7 beats/min (IQR, 5.9-9.9 beats/min). During a median follow-up of 6.7 years, AF was identified in 14.1% of the patients with High-CVD-Risk OSA (n = 687), 10.1% of the patients with Low-CVD-Risk OSA (n = 278), and 8.4% of the patients with non-OSA (n = 714). Compared with the non-OSA group, an increased hazard ratio for AF was found in the High-CVD-Risk OSA group (hazard ratio, 1.68; 95% CI, 1.17-2.41), but not in the Low-CVD-Risk OSA group (hazard ratio, 1.20; 95% CI, 0.76-1.92). The adjusted hazard ratio was similar in female and male participants (hazard ratio, 1.71 [95% CI, 1.01-2.91] vs 1.64 [95% CI, 0.99-2.72]).
interpretationOur results show that OSA-related hypoxemia or heart rate surge may be useful for predicting which patients with OSA are at increased risk of incident AF.
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