Documented Obstructive Sleep Apnea, Cardiometabolic Phenotype, and Rhythm-Related Outcomes After Atrial Fibrillation Ablation: An Observational Cohort Study.

Background: Obstructive sleep apnea syndrome (OSAS) is common in atrial fibrillation (AF) and may influence AF phenotype and post-ablation recurrence. We aimed to determine whether documented OSAS identifies a distinct clinical phenotype and whether it is associated with post-ablation rhythm-related outcomes. Methods: We performed a single-center observational study with two overlapping cohorts. The principal registry cohort comprised 2559 patients with first AF ablation with pulmonary vein isolation (PVI) treated between November/2021 and July/2025. Its primary endpoint was the same-center rhythm-intervention endpoint, defined as the first post-index repeat PVI or electrical cardioversion at the study center. A 7-day Holter was scheduled 90 days after ablation. The nested active 2022 cohort comprised 666 AF/PVI patients. Results: Documented OSAS was present in 268 of 2559 registry patients, 10.5%, and in 66 of 652 patients with known OSAS status in the active subset, 10.1%. Documented OSAS was associated with higher BMI, more obesity, hypertension, diabetes, persistent AF, higher triglycerides and liver enzymes, and lower HDL cholesterol. In the registry cohort, the same-center rhythm-intervention endpoint occurred in 59/268 patients with documented OSAS (22.0%) and 521/2291 without documented OSAS (22.7%; Conclusion: Documented OSAS identified an adverse cardiometabolic AF ablation phenotype but was not independently associated with same-center rhythm interventions.