The presence of obstructive sleep apnoea and the risk of cardiovascular disease in individuals with atrial fibrillation

Study type
Protocol
Date of Approval
Study reference ID
23_003247
Lay Summary

Atrial fibrillation (AF) is a heart condition that causes an irregular and often abnormally fast heart rate, affecting 37 million people worldwide and accounts for about one-third of hospital admission for cardiac rhythm disturbances (irregular heartbeat), and has been linked to an increased risk of cardiovascular diseases (CVD, a general term for conditions affecting the heart or blood vessels). As a common coexisting condition in individuals with AF, obstructive sleep apnoea (OSA is when a blockage in your airway keeps air from moving through your windpipe while you're asleep) shares many common risk factors and consequences with AF. According to the current guidelines, assessment of risk factors and subsequent use of appropriate therapy in individuals with AF is crucial in the prevention of CVD and AF-related complications. However, the limited and often conflicting evidence available, means that it was uncertain if the presence of OSA would further increase the risk of CVD in individuals with AF, implying the need for large population-based studies in this regard. We hypothesise that the presence of OSA may further increase the risk of CVD in individuals with AF. The aim of this study is to investigate the association between OSA and the incidence of CVD in individuals with AF. If this assocaition can be confirmed, given the OSA morbidity in individuals with AF and its potential impact on cardiovascular disease and quality of life, proactive detection and management of OSA in individuals with AF may further support the holistic care of these individuals.

Technical Summary

Aim:
To investigate whether the presence of obstructive sleep apnoea (OSA) is associated with the risk of cardiovascular diseases (CVD) in individuals with atrial fibrillation (AF).

Method:
Individuals with OSA will be compared with matched individuals without OSA for the risk of developing CVD in later life. Competing risk Cox proportional hazard regression models will be used to calculate crude hazard ratios (crude HRs) and adjusted hazard ratios (adjusted HRs), together with their corresponding 95% CIs. Death during the follow-up period will be treated as a competing event.

Outcomes:
The primary outcome is composite CVD. The secondary outcomes are ischaemic heart disease (IHD), heart failure (HF), and stroke or transient ischaemic attack (stroke/TIA).

Exposure and comparator:
Individuals with AF and OSA will be compared to those with AF but not OSA.

Participants:
Adults aged 18 years and above with a diagnosis of AF and registered between 1st of January 2000 and to 31st of December 2022. All participants must have been registered with the general practice for at least one year before the index date (start of follow-up). For each sub-cohort created for one specific outcome, individuals with a record of the corresponding outcome condition at baseline will be excluded.

Covariates:
Sociodemographic characteristics, behavioural risk factors, comorbidities, biomarkers, and medications will be adjusted to account for residual confounding.

Intended public health benefit:
If the association of OSA and CVD in individuals with AF can be confirmed, given the OSA morbidity in individuals with AF and its potential impact on cardiovascular disease and quality of life, proactive detection and management of OSA in individuals with AF may further support the holistic care of these individuals.

Health Outcomes to be Measured

The primary outcome is composite CVD. The secondary outcomes are ischaemic heart disease (IHD), heart failure (HF), and stroke or transient ischaemic attack (stroke/TIA).

Collaborators

Jingya Wang - Chief Investigator - University of Birmingham
Jingya Wang - Corresponding Applicant - University of Birmingham
G. Neil Thomas - Collaborator - University of Birmingham
Gregory Lip - Collaborator - University of Liverpool
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham

Linkages

Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation