Rachel P Ogilvie1,2, Richard F MacLehose2, Alvaro Alonso3, Faye L Norby2, Kamakshi Lakshminarayan2, Conrad Iber4, Lin Y Chen5, Pamela L Lutsey2. 1. From the Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 2. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. 3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 4. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN. 5. Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
Abstract
BACKGROUND: Atrial fibrillation and obstructive sleep apnea are common conditions, but little is known about obstructive sleep apnea and cardiovascular risk among atrial fibrillation patients. METHODS: Using the Truven Health MarketScan databases, we constructed a prospective cohort of atrial fibrillation patients from 2007 to 2014. Atrial fibrillation, obstructive sleep apnea, stroke, myocardial infarction, and confounders were defined using the International Classification of Disease-9-CM codes. We matched individuals with an obstructive sleep apnea diagnosis with up to five individuals without a diagnosis by age, sex, and enrollment date. Cox proportional hazards models adjusted for confounders and high-dimensional propensity scores. We included migraines as a control outcome. Bias analysis used published sensitivities and specificities to generate rate ratios adjusted for obstructive sleep apnea misclassification. RESULTS: We matched 56,969 individuals with an obstructive sleep apnea diagnosis to 323,246 without. During a mean follow-up of 16 months, 3234 incident strokes and 4639 incident myocardial infarctions occurred. After adjustment, obstructive sleep apnea diagnosis was strongly associated with reduced risk of incident stroke (hazard ratio = 0.48, 95% confidence interval = 0.43, 0.53) and myocardial infarction (0.40, [0.37, 0.44]) and a smaller reduced risk of migraines (0.82, [0.68, 0.99]). Bias analysis produced wide-ranging or inestimable rate ratios adjusted for misclassification of obstructive sleep apnea. CONCLUSIONS: Obstructive sleep apnea diagnosis in atrial fibrillation patients was strongly associated with reduced risk of incident cardiovascular disease. We discuss misclassification, selection bias, and residual confounding as potential explanations.
BACKGROUND: Atrial fibrillation and obstructive sleep apnea are common conditions, but little is known about obstructive sleep apnea and cardiovascular risk among atrial fibrillation patients. METHODS: Using the Truven Health MarketScan databases, we constructed a prospective cohort of atrial fibrillation patients from 2007 to 2014. Atrial fibrillation, obstructive sleep apnea, stroke, myocardial infarction, and confounders were defined using the International Classification of Disease-9-CM codes. We matched individuals with an obstructive sleep apnea diagnosis with up to five individuals without a diagnosis by age, sex, and enrollment date. Cox proportional hazards models adjusted for confounders and high-dimensional propensity scores. We included migraines as a control outcome. Bias analysis used published sensitivities and specificities to generate rate ratios adjusted for obstructive sleep apnea misclassification. RESULTS: We matched 56,969 individuals with an obstructive sleep apnea diagnosis to 323,246 without. During a mean follow-up of 16 months, 3234 incident strokes and 4639 incident myocardial infarctions occurred. After adjustment, obstructive sleep apnea diagnosis was strongly associated with reduced risk of incident stroke (hazard ratio = 0.48, 95% confidence interval = 0.43, 0.53) and myocardial infarction (0.40, [0.37, 0.44]) and a smaller reduced risk of migraines (0.82, [0.68, 0.99]). Bias analysis produced wide-ranging or inestimable rate ratios adjusted for misclassification of obstructive sleep apnea. CONCLUSIONS: Obstructive sleep apnea diagnosis in atrial fibrillation patients was strongly associated with reduced risk of incident cardiovascular disease. We discuss misclassification, selection bias, and residual confounding as potential explanations.
Authors: Virend K Somers; David P White; Raouf Amin; William T Abraham; Fernando Costa; Antonio Culebras; Stephen Daniels; John S Floras; Carl E Hunt; Lyle J Olson; Thomas G Pickering; Richard Russell; Mary Woo; Terry Young Journal: J Am Coll Cardiol Date: 2008-08-19 Impact factor: 24.094
Authors: Gen-Min Lin; Laura A Colangelo; Donald M Lloyd-Jones; Susan Redline; Joseph Yeboah; Susan R Heckbert; Saman Nazarian; Alvaro Alonso; David A Bluemke; Naresh M Punjabi; Moyses Szklo; Kiang Liu Journal: Am J Epidemiol Date: 2015-05-13 Impact factor: 4.897
Authors: N McArdle; G Devereux; H Heidarnejad; H M Engleman; T W Mackay; N J Douglas Journal: Am J Respir Crit Care Med Date: 1999-04 Impact factor: 21.405
Authors: Younghoon Kwon; Sina A Gharib; Mary L Biggs; David R Jacobs; Alvaro Alonso; Daniel Duprez; Joao Lima; Gen-Min Lin; Elsayed Z Soliman; Reena Mehra; Susan Redline; Susan R Heckbert Journal: Thorax Date: 2015-05-18 Impact factor: 9.139
Authors: R Doug McEvoy; Nick A Antic; Emma Heeley; Yuanming Luo; Qiong Ou; Xilong Zhang; Olga Mediano; Rui Chen; Luciano F Drager; Zhihong Liu; Guofang Chen; Baoliang Du; Nigel McArdle; Sutapa Mukherjee; Manjari Tripathi; Laurent Billot; Qiang Li; Geraldo Lorenzi-Filho; Ferran Barbe; Susan Redline; Jiguang Wang; Hisatomi Arima; Bruce Neal; David P White; Ron R Grunstein; Nanshan Zhong; Craig S Anderson Journal: N Engl J Med Date: 2016-08-28 Impact factor: 91.245
Authors: Yuka Kiyota; Sebastian Schneeweiss; Robert J Glynn; Carolyn C Cannuscio; Jerry Avorn; Daniel H Solomon Journal: Am Heart J Date: 2004-07 Impact factor: 4.749
Authors: J Daniel Kelly; Dawn M Bravata; Stephen Bent; Charlie M Wray; Samuel J Leonard; W John Boscardin; Laura J Myers; Salomeh Keyhani Journal: JAMA Netw Open Date: 2021-06-01