Sleep apnea independently predicts incident atrial fibrillation in the young - Implications for targeted screening

Abstract Background The risk factors predisposing to AF and ischemic stroke are not well defined in the younger population. That said, routine screening for neither obstructive sleep apnea (OSA) nor atrial fibrillation (AF) is recommended, although these risk factors comigrate. We hypothesized that OSA independently predicts AF in the young. Methods We mined electronic data from 2008 to 2022 from a large suburban academic and community healthcare system, for the endpoint of incident AF in 20-50Y adults. We related the endpoint to covariates including CHADSVASC components, OSA, race and socioeconomic factors prior to the diagnosis of AF, excluding patients with existing (prevalent) AF, hemorrhagic stroke, hypercoagulability and central sleep apnea. Results From an overall population of 1.7MM, we identified 765,645 aged 20-50Y. Of these, 7500 had OSA. In the follow-up period, 4833 young individuals (45 per 100K person-years) experienced incident AF. Sleep apnea [HR:5.16; (4.68, 5.68)] was the non-CHADSVASC strongest risk factor for incident AF, other than CKD [HR:3.74 (3.20,4.38)], Black race [HR:1.30 (1.16,1.46)], Hispanic ethnicity [HR:1.20; (1.10, 1.32)] and smoking [HR:1.32; (1.24, 1.41)] (Figure 1A). Within CHADSVASC, other than heart failure [HR:10.23; (8.94,11.80)], all the other components had lower hazards than sleep apnea (Figure 1B). The C-index of CHADSVASC score is 0.51 which is augmented to 0.65 (P<0.05) with addition of OSA, CKD, race, ethnicity and smoking. Conclusions In a population of over 700 thousand 20–50-year-old adults, sleep apnea is a strong independent predictor for incident AF. This has implications for screening and therapy of young patients.