Sleep Apnea Increases Major Adverse Cardiovascular Events Patients with Atrial Fibrillation

Abstract 2302500, presented at Western Atrial Fibrillation Symposium 2026

Obstructive Sleep Apnea Increases the Risk of Major Adverse Cardiovascular Events and Stroke in Patients with Atrial FibrillationUsing the TriNetX electronic health record database, we compared MACE incidence in AF patients with and without OSA from November 2004 to November 2024. MACE was defined as a composite of ischemic heart disease, stroke (ischemic/hemorrhagic), heart failure, ventricular arrhythmia, and cardiac arrest. Patients were included at AF diagnosis, with follow-up starting three months later until the outcome or end of the study (median follow-up: 782 days). Propensity matching adjusted for more than 30 patient characteristics including age, sex, body mass index, comorbidities, and labs. After propensity matching, time-to-event analysis was done.A total of 42,720 patients with AF and OSA were propensity-matched to 42,720 AF patients without OSA. Over a median follow-up of 782 days, 15,819 MACE events were recorded. OSA was associated with a significantly increased risk of MACE (HR: 1.297, 95% CI: 1.256–1.338) (Figure A). It was also associated with increased risk of specific cardiovascular events including ischemic heart disease (HR: 1.273, 95% CI: 1.226–1.321), stroke (HR: 1.124, 95% CI: 1.026–1.232), and heart failure (HR: 1.493, 95% CI: 1.432–1.556). CPAP users (n=10,223) were then compared to propensity-matched non-OSA patients (n=10,223) to assess whether CPAP treatment ameliorates the increased risk associated with OSA. CPAP users had a persistently higher risk of MACE (HR: 1.794; 95% CI: 1.692–1.901), ischemic heart disease (HR: 1.75; 95% CI: 1.629-1.880), stroke (HR=1.47; 95% CI: (1.236, 1.749), and heart failure (HR: 2.113;95% CI: (1.965, 2.273) compared to patients with no OSA (Figure B).OSA in patients with AF was associated with increased risk of MACE, ischemic heart disease, stroke, and heart failure, with elevated risk persisting in CPAP users.