| 1. |
- Holtstrand Hjälm, Henrik, et al.
(författare)
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Association between left atrial enlargement and obstructive sleep apnea in a general population of 71-year-old men.
- 2018
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Ingår i: Journal of sleep research. - : Wiley. - 1365-2869 .- 0962-1105. ; 27:2, s. 254-260
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Tidskriftsartikel (refereegranskat)abstract
- Left atrial enlargement has been shown to be associated with obstructive sleep apnea in patients with coronary artery disease and in sleep clinic cohorts. However, data from the general population are limited. The aim of this study was to investigate whether there is an association between obstructive sleep apnea and left atrial enlargement in a random sample from a general population of 71-year-old men. As part of the longitudinal population study The Study of Men Born in 1943, we analysed cross-sectional data for 411 men, all 71years old, who had participated in an overnight home sleep study and a standardized echocardiographic examination. Of the 411 men, 29.4% had moderate to severe obstructive sleep apnea [apnea-hypopnea index score of ≥15 (n=121)]. These participants showed a significantly higher frequency of systolic heart failure, hypertension, overweight, had greater waist circumference as well as higher left atrial areas compared with men with no or mild obstructive sleep apnea (23.7±5.5cm2 versus 21.6±4.5cm2 , P<0.001). In a linear regression analysis, obstructive sleep apnea was significantly associated with left atrial enlargement after adjusting for overweight, atrial fibrillation, heart failure with reduced ejection fraction, hypertension and mitral regurgitation. Compared with individuals without obstructive sleep apnea, the mean left atrial area was 1.7±1.5cm2 larger in men with severe obstructive sleep apnea (P<0.05) and 1.3±1.1cm2 larger among men with moderate obstructive sleep apnea (P<0.05). In this cross-sectional study of 71-year-old men from the general population, left atrial area was independently associated with prevalence and severity of obstructive sleep apnea.
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| 2. |
- Holtstrand Hjälm, Henrik, et al.
(författare)
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Obstructive sleep apnea severity and prevalent atrial fibrillation in a sleep clinic cohort with versus without excessive daytime sleepiness
- 2023
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Ingår i: Sleep Medicine. - 1389-9457. ; 112, s. 63-69
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF) in cardiac cohorts. Less is known regarding the magnitude of this association in a sleep clinic cohort with vs. without excessive daytime sleepiness (EDS). Objectives: To explore the association of OSA severity with AF in a sleep clinic cohort stratified by EDS. Patients and methods: All consecutive adults (n = 3814) admitted to the Skaraborg Hospital, Sweden between Jan 2005 and December 2011 were registered in a local database, and the follow-up ended in December 2018. OSA was defined as an apnea-hypopnea index (AHI) >= 5 events/h. Mild OSA was defined as AHI >= 5 & AHI<15 events/ h; moderate OSA as AHI >= 15 & AHI<30 events/h; and severe OSA as AHI >= 30 events/h. EDS was defined as an Epworth Sleepiness Scale score >= 11. We conducted cross-sectional analyzes of the prevalent AF across the OSA severity categories and logistic regression analyzes stratified by EDS.Results: In all, 202 patients (5.3%) had AF at baseline, 1.6% in no-OSA, 3.9% in mild OSA, 5.2% in moderate OSA, and 7.6% in severe OSA, respectively (p < 0.001). The stratified analyzes revealed that patients with severe OSA without EDS had an increased risk for prevalent AF (OR 2.54, 95% CI 1.05-6.16; p = 0.039) independent of the confounding factors. Conclusions: There was an independent dose-response relationship between OSA and prevalent AF among the non-sleepy phenotype in this sleep clinic cohort. Since adherence to OSA treatment is challenging in the absence of EDS, these patients may have increased risk for adverse cardiovascular outcomes.
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| 3. |
- Holtstrand Hjälm, Henrik
(författare)
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Sleep apnea and atrial fibrillation: cause or comorbidity?
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are common conditions, associated with morbidity and mortality. Both OSA and AF often go undetected. It has been suggested that OSA may be a modifiable risk factor for AF development. OSA has been linked with AF prevalence in general cohorts and with enlargement of the atria in sleep lab cohorts. In addition, OSA has been associated with postoperative AF (POAF) after coronary artery bypass graft (CABG) in coronary artery disease (CAD) cohorts. Aims: The papers described in this thesis aim to address the following issues: (1) the association between OSA and AF prevalence, (2) the association between OSA and left atrial enlargement in a general population, (3) whether OSA severity and excessive daytime sleepiness (EDS) were associated with AF, (4) whether OSA severity was associated with OSA incidence in a sleep clinic cohort, and (5) whether OSA was associated with POAF in a CAD cohort. Methods and Results: This thesis consists of five papers, with data from three cohorts. Paper I and paper II are based on the longitudinal cohort “The Study of Men Born in 1943”, consisting of a random sample of men from the general population living in Gothenburg, Sweden, recruited in 1993. In 2014, the 653 remaining men were invited to a re-examination, of whom 536 participated. This re-examination included a physical examination, ECG, two-week thumb ECG, a home sleep apnea test (HSAT), an echocardiographic examination, and questionnaires. The 412 participants with complete data from the HSAT were included. Paper I showed that AF is much more common among men with severe OSA compared to men with no, mild, or moderate OSA. While the association with severe OSA was found to be significant in adjusted analyses, it may be mediated by known confounding factors, mainly heart failure. Paper II showed an independent linear association between left atrial enlargement and OSA severity. Paper III and paper IV are based on the “Sleep Apnea Patients in Skaraborg” cohort. All consecutive patients referred to the sleep clinics at Skaraborg Hospital in southwestern Sweden between January 2005 and December 2011 were included. Patients were screened using HSAT and they filled out questionnaires concerning EDS. Follow-up of comorbidities, through review of hospital records ended in April 2018. A total of 4239 adult patients were included in the cohort. Paper III showed an independent association between OSA and AF prevalence in OSA patients without EDS. In paper IV, OSA severity was associated with shorter survival free time concerning AF incidence, and moderate and severe OSA were associated with AF incidence in unadjusted analyses. In adjusted analyses, this association was no longer significant, indicating that heart failure and age are major confounders and are involved in AF incidence. Paper V is a secondary analysis of data from the Randomized Intervention with Continuous Positive Airway Pressure (CPAP) in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial. This secondary trial includes 147 patients who underwent HSAT after CABG between December 2005 and November 2010. Paper V showed a linear association between OSA severity and POAF within 30 days, and severe OSA was significantly associated with POAF. Conclusions: OSA severity, and foremost severe OSA, was associated with AF prevalence and left atrial enlargement in a general male population. In our sleep clinic cohort, severe OSA without EDS was associated with AF, a patient group for which CPAP treatment may be challenging. Severe OSA was associated with AF in the survival analyses. Furthermore, severe OSA was associated with AF after CABG. Overall, severe OSA was associated with worse outcomes when compared to patients with no, mild, or moderate OSA. AF or POAF was more prevalent in patients with severe OSA in all cohorts.
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| 4. |
- Peker, Yüksel, 1961, et al.
(författare)
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Postoperative Atrial Fibrillation in Adults with Obstructive Sleep Apnea Undergoing Coronary Artery Bypass Grafting in the RICCADSA Cohort
- 2022
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 11:9
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative atrial fibrillation (POAF) occurs in 20-50% of patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG). Obstructive sleep apnea (OSA) is also common in adults with CAD, and may contribute to POAF as well to the reoccurrence of AF in patients at long-term. In the current secondary analysis of the Randomized Intervention with Continuous Positive Airway Pressure (CPAP) in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), we included 147 patients with CABG, who underwent a home sleep apnea testing, in average 73 +/- 30 days after the surgical intervention. POAF was defined as a new-onset AF occurring within the 30 days following the CABG. POAF was observed among 48 (32.7%) patients, occurring within the first week among 45 of those cases. The distribution of the apnea-hypopnea-index (AHI) categories < 5.0 events/h (no-OSA); 5.0-14.9 events/h (mild OSA); 15.0-29.9 events/h (moderate OSA); and >= 30 events/h (severe OSA), was 4.2%, 14.6%, 35.4%, and 45.8%, in the POAF group, and 16.2%, 17.2%, 39.4%, and 27.3%, respectively, in the no-POAF group. In a multivariate logistic regression model, there was a significant risk increase for POAF across the AHI categories, with the highest odds ratio (OR) for severe OSA (OR 6.82, 95% confidence interval 1.31-35.50; p = 0.023) vs. no-OSA, independent of age, sex, and body-mass-index. In the entire cohort, 90% were on beta-blockers according to the clinical routines, they all had sinus rhythm on the electrocardiogram at baseline before the study start, and 28 out of 40 patients with moderate to severe OSA (70%) were allocated to CPAP. During a median follow-up period of 67 months, two patients (none with POAF) were hospitalized due to AF. To conclude, severe OSA was significantly associated with POAF in patients with CAD undergoing CABG. However, none of those individuals had an AF-reoccurrence at long term, and whether CPAP should be considered as an add-on treatment to beta-blockers in secondary prevention models for OSA patients presenting POAF after CABG requires further studies in larger cohorts.
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