TY - JOUR
T1 - Race, sex, age, and regional differences in the association of obstructive sleep apnea with atrial fibrillation
T2 - Reasons for geographic and racial differences in stroke study
AU - Ghazi, Lama
AU - Bennett, Aleena
AU - Petrov, Megan
AU - Howard, Virginia J.
AU - Safford, Monika M.
AU - Soliman, Elsayed Z.
AU - Glasser, Stephen P.
N1 - Funding Information:
The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org. All authors have seen and approved the manuscript. The authors report no conflicts of interest. This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. We are also supported by K24: 1K24HL111154 and REGARDS: R01HL080477. Representatives of the funding agency have been involved in the review of the article but not directly involved in the collection, management, analysis, or interpretation of the data.
Funding Information:
All authors have seen and approved the manuscript. The authors report no conflicts of interest. This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. We are also supported by K24: 1K24HL111154 and REGARDS: R01HL080477. Representatives of the funding agency have been involved in the review of the article but not directly involved in the collection, management, analysis, or interpretation of the data.
Publisher Copyright:
© 2018 American Academy of Sleep Medicine. All rights reserved.
PY - 2018/9/15
Y1 - 2018/9/15
N2 - Study Objectives: To examine the cross-sectional association between obstructive sleep apnea (OSA) risk and atrial fibrillation (AF) in the REasons for Geographic And Racial Differences in Stroke (REGARDS), a cohort of black and white adults. Methods: Using REGARDS data from subjects recruited between 2003–2007, we assessed 20,351 participants for OSA status. High OSA risk was determined if the participant met at least two criteria from the Berlin Sleep Questionnaire (persistent snoring, frequent sleepiness, high blood pressure, or obesity). AF was defined as a self-reported history of a previous physician diagnosis or presence of AF on electrocardiogram. Logistic regression was used to determine odds ratio and 95% confidence interval for the association between OSA status and AF with subgroup analysis to examine effect modification by age, race, sex, and geographical region. Results: The prevalence of AF was 7% (n = 1,079/14,992) and 9% (n = 482/5,359) in participants at low and high risk of OSA, respectively (P < .0001). Persons at high risk of OSA had greater prevalence of diabetes and stroke history, and were more likely to be obese and taking sleep medications. In a multivariable analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, high risk for OSA was associated with an increased odds of AF compared to low risk for OSA (odds ratio = 1.27, 95% confidence interval = 1.13, 1.44). This association differed significantly only by race (P for interaction = .0003). For blacks, there was a significant 58% increase in odds of AF in participants at high risk versus low risk of OSA, compared to a nonsignificant 12% increase in odds in whites. We were limited by self-reported variables, inability to adjust for obesity, and the cross-sectional nature of our study. Conclusions: High risk of OSA is associated with prevalent AF among blacks but not whites. Commentary: A commentary on this article appears in this issue on page 1459.
AB - Study Objectives: To examine the cross-sectional association between obstructive sleep apnea (OSA) risk and atrial fibrillation (AF) in the REasons for Geographic And Racial Differences in Stroke (REGARDS), a cohort of black and white adults. Methods: Using REGARDS data from subjects recruited between 2003–2007, we assessed 20,351 participants for OSA status. High OSA risk was determined if the participant met at least two criteria from the Berlin Sleep Questionnaire (persistent snoring, frequent sleepiness, high blood pressure, or obesity). AF was defined as a self-reported history of a previous physician diagnosis or presence of AF on electrocardiogram. Logistic regression was used to determine odds ratio and 95% confidence interval for the association between OSA status and AF with subgroup analysis to examine effect modification by age, race, sex, and geographical region. Results: The prevalence of AF was 7% (n = 1,079/14,992) and 9% (n = 482/5,359) in participants at low and high risk of OSA, respectively (P < .0001). Persons at high risk of OSA had greater prevalence of diabetes and stroke history, and were more likely to be obese and taking sleep medications. In a multivariable analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, high risk for OSA was associated with an increased odds of AF compared to low risk for OSA (odds ratio = 1.27, 95% confidence interval = 1.13, 1.44). This association differed significantly only by race (P for interaction = .0003). For blacks, there was a significant 58% increase in odds of AF in participants at high risk versus low risk of OSA, compared to a nonsignificant 12% increase in odds in whites. We were limited by self-reported variables, inability to adjust for obesity, and the cross-sectional nature of our study. Conclusions: High risk of OSA is associated with prevalent AF among blacks but not whites. Commentary: A commentary on this article appears in this issue on page 1459.
KW - Atrial fibrillation
KW - Obstructive sleep apnea
KW - REGARDS
KW - Racial differences
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U2 - 10.5664/jcsm.7320
DO - 10.5664/jcsm.7320
M3 - Article
C2 - 30176963
AN - SCOPUS:85053206344
SN - 1550-9389
VL - 14
SP - 1485
EP - 1493
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 9
ER -