Allagoa, Theresa

Introduction: Obesity is a known risk factor and causes worse cardiovascular outcomes in obstructive sleep apnea. With the growing use of cannabis in the US, so we aimed to assess the impact of cannabis use disorder (CUD) on risk of atrial tachyarrhythmias (atrial fibrillation, AF; atrial fibrillation, AFL) and stroke in young patients with obesity-associated obstructive sleep apnea (OOSA). Methods: The National Inpatient Sample (2015Oct-2017) with relevant ICD-10 codes were used to identify admissions among young adults (18-44 years) with OOSA. We then matched (1:1) two cohorts of cannabis use disorder (CUD+) vs. without (CUD-) with controlling potential sociodemographic confounders. Primary outcomes of interest were frequency and risk of atrial tachyarrhythmias and stroke assessed by multivariable analysis. Results: Of 7470 demographically-matched OOSA admissions, CUD+ and CUD- cohorts had 3735 hospitalizations in each cohort. Both cohorts were comparable mean age of 38 years and CUD+ cohort more frequently included male (66.6% vs. 53.5%), African American (40.0% vs. 30.1%) patients admitted non-electively (92.3% vs. 84.5%). Rates of drug abuse, hypertension, smoking and chronic pulmonary disease were higher but diabetes mellitus, hyperlipidemia, and renal failure were lower in CUD+ cohort vs. CUD- cohort (p<0.001). The frequency of AF/AFL (5.7% vs 7.4%) related admissions were lower; however, the risk of AF/AFL (OR:1.64, 95%CI:1.17-2.30, p=0.004) and stroke (OR:4.41, 95%CI:1.41-13.77, p<0.011) admissions were significantly higher in the OOSA-CUD+ cohort vs. CUD- cohort in the multivariable analysis controlled for relevant cardiovascular/extracardiac comorbidities and concomitant alcohol/drug abuse and smoking. Conclusions: This propensity-matched analysis highlights that recreational cannabis use in young patients with OOSA may alarmingly increase emergency hospitalizations and independently increase the risk of AF/AFL and stroke.

Background: Bariatric surgery (BS) has been shown to be beneficial in improving co-morbid conditions in morbidly obese patients. Long-term cardiovascular complications remain undefined and warrant further investigation. We examined the prevalence and risk of atrial fibrillation (AF) in obese patients who underwent BS. Methods: PUBMED/Medline, SCOPUS, EMBASE databases were systematically reviewed using relevant keywords to search prospective and retrospective studies reporting AF with long-term (at least >1-year follow-up) follow-up in patients who had undergone BS. Random effects models were used for meta-analysis and subgroup analysis. I 2 statistics was used to identify substantial (>75%) heterogeneity. Results: Nine studies (3 USA, 2 UK, 4 Sweden) including 24,164 patients who had undergone BS (mean BMI cut off: 35, mean age 42 years) with 29,330 controls were included in the analysis with a median follow-up of 8 years. Pooled prevalence of AF was lower in BS arm (3.0%, 95%CI: 1.4%-5%) as compared to non-BS arm (3.8%, 95% CI: 1.8%-5.0%). The Forest Plot (Fig. 1) depicts significantly reduced odds of having AF in patients who have undergone BS vs controls (OR: 0.74, 95%CI: 0.60-0.91, I 2 =70.2%, p<0.01). Sensitivity analysis using the leave-one-out method did confirm equivalent results. On subgroup analysis, AF prevalence in the BS group was slightly higher in studies with a mean age of ≥50 years (4.8%, 0-12%) as compared to cohorts with mean age <50 (2.0%, 1.4-5.0%). The pooled rate of AF was low on short-term follow-up compared to long-term follow-up after BS: 1.5% (0.9-2.5%) in 1-5 years, 1.9% (0.2-4.5%) in 6-10 years, 5.4% (0-13.9%) ≥10 years of BS. Conclusions: Obese patients undergoing BS had nearly 25% lower risk and lower pooled rate of AF when compared to controls over 8 years of follow-up. The protective effect of BS on reduced risk of AF was seen to gradually wane over longer follow-up which warrants continued efforts to effectively control CVD risk factors.