Sleep Apnea Increases the Risk of New Hospitalized Atrial Fibrillation: A Historical Cohort Study Q&A With Co-Author Tetyana Kendzerska, MD, PhD

By: Vanessa Claude

December 18, 2018

1. What effect do you hope the findings of this study will have on identifying patients with OSA who are at the greatest risk of developing atrial fibrillation (AF)?

Our findings can help identify those patients with sleep apnea who are at the greatest risk of developing AF and who may need more aggressive treatment. Further, findings from our study underscore the potential importance of nocturnal hypoxemia in mediating cardiovascular risk from obstructive sleep apnea and raise the question of whether a more direct measure of variability and severity of nocturnal hypoxia might be even more predictive than apnea-hypopnea index (a traditional measure of obstructive sleep apnea severity).

2. What are some factors that could enhance this study further?

As with any observational study design, there are limitations related to availability of data on important confounders (eg, treatment adherence; left atrial size; and presence of obesity hypoventilation syndrome, congenital heart disease, or valvular heart disease). Further, the generalizability of our findings may be limited by a single center study design and of Ontario residents only. Our findings are also limited to the hospitalized AF, which may represent a different phenotype of AF compared with asymptomatic and nonhospitalized AF. To extend our study further, we need to confirm these findings in multicenter studies, including any new AF to identify characteristics of those at high risk for AF development. Based on those results, we then design a clinical trial on the effect of PAP (positive airway pressure treatment) on AF prevention in individuals with OSA.

3. Are there any findings that you’d like to expand on in the future, and what results would you like to find?

Our findings indicate that nocturnal hypoxemia imparts a greater risk of incident AF in women than men and in those younger than 65 years old as compared with those older than 65 years old. This suggests that these groups, who are typically at somewhat lower risk of AF, might be especially vulnerable to the effects of OSA and hypoxemia. We would expand our research on these specific subgroups to confirm these findings to be able to develop a targeted management strategy. 

Read the full article: “Sleep Apnea Increases the Risk of New Hospitalized Atrial Fibrillation: A Historical Cohort Study”

Dr. Kendzerska is an associate scientist at the Ottawa Hospital Research Institute, a sleep physician at The Ottawa Hospital Sleep Centre, an assistant professor at the University of Ottawa, and an adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES). Dr. Kendzerska's research interests include the epidemiology of sleep apnea, particularly the relationship between sleep apnea and cardiovascular disease, mortality, diabetes, depression, and cancer; adherence with positive airway pressure treatment; survival analyses; predictive model development; and measurement of patient-related outcomes. She is also interested in the epidemiology of chronic obstructive pulmonary disease and the role of sleep-related disorders in modulating the health consequences of chronic disease.