Soin, S.

Abstract RATIONALE:New-onset atrial fibrillation (NOAF) is a common arrhythmia associated with adverse outcomes in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). Both conditions, through shared mechanisms, raise the likelihood of NOAF incidence, emphasizing the importance of epidemiological data and preventive measures to prevent NOAF burden. Therefore, we examined the risk of NOAF in patients with COPD, OSA, and their overlap syndrome (OS). METHODS: We extracted data from the Banner Healthcare Organization, US Collaborative Network in TriNetX, identifying three patient cohorts using ICD-10 codes for COPD (J40-J44) and OSA (G47.3). This included 73,540 patients with OS, 198,880 patients with OSA only, and 337,010 patients with COPD only. Patients with a prior diagnosis of AF before their diagnosis of OSA or COPD were excluded. Propensity matching was conducted based on age, sex, ethnicity, and cardiovascular disease risk factors and prevalence including hypertension, tobacco use, dyslipidemia, obesity, and ischemic heart disease. We calculated the relative risk (RR), hazard ratio (HR), and 95% confidence intervals (CI) for incident AF among propensity score-matched cohorts, comparing OS with OSA alone and OS with COPD alone.RESULTS: In the OS vs. OSA only comparison, 63,070 patients were matched per cohort. Lifetime incidence of new AF was higher in the OS group (13.65%) compared to the OSA-only group (8.24%), with an RR of 1.66 [95% CI: 1.60-1.72]. Kaplan-Meier analysis indicated a lower AF-free probability in the OS group (65.96%) than in the OSA-only group (77.03%), with an HR of 1.56 (p < 0.001). In the OS vs. COPD only comparison, 65,810 patients were matched per cohort. Incidence of new AF in the OS group was 13.76%, compared to 9.86% in the COPD-only group, with an RR of 1.40 [95% CI: 1.35-1.44]. Kaplan-Meier analysis showed a lower AF-free probability for the OS group (66.13%) versus the COPD-only group (78.94%), with an HR of 1.28 (p < 0.001). Sensitivity analyses restricted to the first five years post-diagnosis revealed a persistently higher relative risk of incident AF in OS patients, with an RR of 1.67 [95% CI: 1.60-1.73] compared to OSA alone, and an RR of 1.34 [95% CI: 1.29-1.39] compared to COPD alone. CONCLUSION:We identified that patients with OS have a higher risk of NOAF compared to either condition alone. This emphasizes the need for vigilant monitoring and targeted interventions in patients with OS to decrease arrhythmogenicity risks.