title: Association of atrial fibrillation and obstructive sleep apnea.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is associated with recurrent atrial fibrillation (AF) after electrocardioversion. OSA is highly prevalent in patients who are male, obese, and/or hypertensive, but its prevalence in patients with AF is unknown.
  
  
  RESULTS
  We prospectively studied consecutive patients undergoing electrocardioversion for AF (n=151) and consecutive patients without past or current AF referred to a general cardiology practice (n=312). OSA was diagnosed with the Berlin questionnaire, which is validated to identify patients with OSA. We also assessed its accuracy compared with polysomnography in a sample of the study population. Groups were compared with the 2-tailed t, Wilcoxon, and chi2 tests. Logistic regression modeled the association of AF and OSA after adjustment for relevant covariates. Patients in each group had similar age, gender, body mass index, and rates of diabetes, hypertension, and congestive heart failure. The questionnaire performed with 0.86 sensitivity, 0.89 specificity, and 0.97 positive predictive value in our sample. The proportion of patients with OSA was significantly higher in the AF group than in the general cardiology group (49% versus 32%, P=0.0004). The adjusted odds ratio for the association between AF and OSA was 2.19 (95% CI 1.40 to 3.42, P=0.0006).
  
  
  CONCLUSIONS
  The novel finding of this study is that a strong association exists between OSA and AF, such that OSA is strikingly more prevalent in patients with AF than in high-risk patients with multiple other cardiovascular diseases. The coinciding epidemics of obesity and AF underscore the clinical importance of these results.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, Minn 55905, USA. somers.virend@mayo.edu
authors.forename: Apoor S
authors.initials: AS
authors.lastname: Gami
authors.forename: Gregg
authors.initials: G
authors.lastname: Pressman
authors.forename: Sean M
authors.initials: SM
authors.lastname: Caples
authors.forename: Ravi
authors.initials: R
authors.lastname: Kanagala
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gard
authors.forename: Diane E
authors.initials: DE
authors.lastname: Davison
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
mesh_terms: D000368:Aged; D000886:Anthropometry; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004554:Electric Countershock; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D009765:Obesity / Q000150:complications; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires