Obstructive Sleep Apnea Syndrome Associated with Atrial Fibrillation in Adult Patients: A Systematic Review and Meta-Analysis


  • Oswaldo Gómez Carrasco Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
  • Bryam Martin Gómez Carrasco Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú https://orcid.org/0000-0002-4871-3144
  • Gerard Gómez Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
  • Rubén Espinoza-Rojas Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú https://orcid.org/0000-0002-1459-3711
  • Eder Jesús Orihuela-Manrique Universidad Tecnológica del Perú, Lima, Perú https://orcid.org/0000-0002-7447-1601
  • Rosa Angélica García-Lara Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
  • Joan A. Loayza-Castro Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú https://orcid.org/0000-0001-6495-6501
  • Gianella Zulema Zeñas-Trujillo Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
  • Víctor Juan Vera-Ponce Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
  • Jhony A. De La Cruz-Vargas Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú https://orcid.org/0000-0002-5592-0504




Sleep Apnea, Obstructive, Obstructive Sleep Apnea, Atrial Fibrillation, Systematic review, Sleep syndrome, public health (Source: MeSH NLM)


Introduction: Obstructive sleep apnea syndrome (OSAHS) is a common disease. However, its diagnosis and treatment are underestimated. The main reason is that the upper airway completely or partially collapses, leading to repeated sleep apnea episodes. In addition, atrial fibrillation(AF) is the most frequent arrhythmia in the world, these two entities may be related and are important public health problems.

Objective: To determine the association between obstructive sleep apnea syndrome and atrial fibrillation in adult patients.

Materials and Methods: A systematic review and meta-analysis of observational studies that associate obstructive sleep apnea syndrome and atrial fibrillation was carried out. The search was carried out in 4 databases: PUBMED, Web of Science, Embase, Scopus.

Results: Eight studies were included (n=562241). A significant association was found between obstructive sleep apnea and atrial fibrillation (OR: 1.38; 95% CI 1.24 to 1.54). In addition, low heterogeneity was found between studies I2: 13%.

Conclusions: It was found that obstructive sleep apnea and atrial fibrillation are significantly associated.


Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, et al. Documento internacional de consenso sobre apnea obstructiva del sueño. Archivos de Bronconeumología 2022; 58(1): 52-68. https://doi.org/10.1016/j.arbres.2021.03.017 DOI: https://doi.org/10.1016/j.arbres.2021.03.017

Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet Respiratory Medicine 2019; 7(8): 687-98. https://doi.org/10.1016/S2213-2600(19)30198-5 DOI: https://doi.org/10.1016/S2213-2600(19)30198-5

Hidalgo-Martínez P, Lobelo R. Epidemiología mundial, latinoamericana y colombiana y mortalidad del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). Rev Fac Med 2017; 65(1Sup): 17-20. https://doi.org/10.15446/revfacmed.v65n1Sup.59565 DOI: https://doi.org/10.15446/revfacmed.v65n1Sup.59565

Chung MK, Refaat M, Shen W-K, Kutyifa V, Cha Y-M, Di Biase L, et al. Atrial Fibrillation. Journal of the American College of Cardiology 2020; 75(14): 1689-713. https://doi.org/10.1016/j.jacc.2020.02.025 DOI: https://doi.org/10.1016/j.jacc.2020.02.025

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6(7): e1000097. https://doi.org/10.1371/journal.pmed.1000097 DOI: https://doi.org/10.1371/journal.pmed.1000097

Ottawa Hospital Research Institute [Internet]. [citado el 11 de julio de 2022]. Disponible en: https://www.ohri.ca/programs/ clinical_epidemiology/oxford.asp

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21(11): 1539-58. https://doi.org/10.1002/sim.1186 DOI: https://doi.org/10.1002/sim.1186

Cochrane Handbook for Systematic Reviews of Interventions [Internet]. [citado el 27 de noviembre de 2021]. Disponible en: https://training.cochrane.org/handbook

Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation. Journal of the American College of Cardiology 2007; 49(5): 565-71. https://doi.org/10.1016/j.jacc.2006.08.060 DOI: https://doi.org/10.1016/j.jacc.2006.08.060

Lin Y-S, Liu P-H, Chu P-H. Obstructive Sleep Apnea Independently Increases the Incidence of Heart Failure and Major Adverse Cardiac Events: A Retrospective Population-Based Follow-Up Study. Acta Cardiol Sin 2017; 33(6): 656-63.

Xu H, Wang J, Yuan J, Hu F, Yang W, Guo C, et al. Implication of Apnea‐Hypopnea Index, a Measure of Obstructive Sleep Apnea Severity, for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. JAHA 2020; 9(8): e015013. https://doi.org/10.1161/JAHA.119.015013 DOI: https://doi.org/10.1161/JAHA.119.015013

Adderley NJ, Subramanian A, Toulis K, Gokhale K, Taverner T, Hanif W, et al. Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study. Diabetes Care 2020; 43(8): 1868-77. https://doi.org/10.2337/dc19-2116 DOI: https://doi.org/10.2337/dc19-2116

Patel SV, Gill H, Shahi D, Rajabalan A, Patel P, Sonani R, et al. High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis. Sleep Breath 2018; 22(4): 1117-24. https://doi.org/10.1007/s11325-018-1645-3 DOI: https://doi.org/10.1007/s11325-018-1645-3

Patel NJ, Wells QS, Huang S, Upender RP, Darbar D, Monahan K. Relation of Obstructive Sleep Apnea and a Common Variant at Chromosome 4q25 to Atrial Fibrillation. The American Journal of Cardiology 2017; 119(9): 1387-91. https://doi.org/10.1016/j.amjcard.2017.01.038 DOI: https://doi.org/10.1016/j.amjcard.2017.01.038

Ghazi L, Bennett A, Petrov ME, Howard VJ, Safford MM, Soliman EZ, et al. Race, Sex, Age, and Regional Differences in the Association of Obstructive Sleep Apnea With Atrial Fibrillation: Reasons for Geographic and Racial Differences in Stroke Study. Journal of Clinical Sleep Medicine 2018; 14(09): 1485-93. https://doi.org/10.5664/jcsm.7320 DOI: https://doi.org/10.5664/jcsm.7320

Feng TR, White RS, Ma X, Askin G, Pryor KO. The effect of obstructive sleep apnea on readmissions and atrial fibrillation after cardiac surgery. Journal of Clinical Anesthesia 2019; 56: 17-23. https://doi.org/10.1016/j.jclinane.2019.01.011 DOI: https://doi.org/10.1016/j.jclinane.2019.01.011

Arias MA, Baranchuk A. Fibrilación auricular y apnea obstructiva del sueño: algo más que una coincidencia. Revista Española de Cardiología 2013; 66(7): 529-31. https://doi.org/10.1016/j.recesp.2013.02.012 DOI: https://doi.org/10.1016/j.recesp.2013.02.012

Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285(18): 2370. https://doi.org/10.1001/jama.285.18.2370 DOI: https://doi.org/10.1001/jama.285.18.2370

Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. CLEP 2014; 213. https://doi.org/10.2147/CLEP.S47385 DOI: https://doi.org/10.2147/CLEP.S47385

Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM, Quan SF, et al. Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure: The Sleep Heart Health Study. Circulation 2010; 122(4): 352-60. https://doi.org/10.1161/CIRCULATIONAHA.109.901801 DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.901801

Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular Trends in Incidence of Atrial Fibrillation in Olmsted County, Minnesota, 1980 to 2000, and Implications on the Projections for Future Prevalence. Circulation 2006; 114(2): 119-25. https://doi.org/10.1161/CIRCULATIONAHA.105.595140 DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.595140

Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. The Lancet 2015; 386(9989): 154-62. https://doi.org/10.1016/S0140-6736(14)61774-8 DOI: https://doi.org/10.1016/S0140-6736(14)61774-8

Huang T, Lin BM, Markt SC, Stampfer MJ, Laden F, Hu FB, et al. Sex differences in the associations of obstructive sleep apnoea with epidemiological factors. Eur Respir J 2018; 51(3): 1702421. https://doi.org/10.1183/13993003.02421-2017 DOI: https://doi.org/10.1183/13993003.02421-2017

Park JG, Ramar K, Olson EJ. Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea. Mayo Clinic Proceedings 2011; 86(6): 549-55. https://doi.org/10.4065/mcp.2010.0810 DOI: https://doi.org/10.4065/mcp.2010.0810

Linz D, McEvoy RD, Cowie MR, Somers VK, Nattel S, Lévy P, et al. Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review. JAMA Cardiol 2018; 3(6): 532. https://doi.org/10.1001/jamacardio.2018.0095 DOI: https://doi.org/10.1001/jamacardio.2018.0095

Cadby G, McArdle N, Briffa T, Hillman DR, Simpson L, Knuiman M, et al. Severity of OSA Is an Independent Predictor of Incident Atrial Fibrillation Hospitalization in a Large Sleep-Clinic Cohort. Chest 2015; 148(4): 945-52. https://doi.org/10.1378/chest.15-0229 DOI: https://doi.org/10.1378/chest.15-0229

Tung P, Levitzky YS, Wang R, Weng J, Quan SF, Gottlieb DJ, et al. Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women. JAHA 2017; 6(7): e004500. https://doi.org/10.1161/JAHA.116.004500 DOI: https://doi.org/10.1161/JAHA.116.004500

Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study. IJC Heart & Vasculature 2021; 35: 100834. https://doi.org/10.1016/j.ijcha.2021.100834 DOI: https://doi.org/10.1016/j.ijcha.2021.100834




How to Cite

Carrasco, O. G. ., Gómez Carrasco, B. M. ., Gómez, G. ., Espinoza-Rojas, R. ., Orihuela-Manrique, E. J. ., García-Lara, R. A. ., Loayza-Castro, J. A. ., Zeñas-Trujillo, G. Z. ., Vera-Ponce, V. J. ., & Cruz-Vargas, J. A. D. L. . (2023). Obstructive Sleep Apnea Syndrome Associated with Atrial Fibrillation in Adult Patients: A Systematic Review and Meta-Analysis. International Journal of Statistics in Medical Research, 12, 43–50. https://doi.org/10.6000/1929-6029.2023.12.06



General Articles

Most read articles by the same author(s)