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Snoring and apnoea linked to higher stroke risk – US study

Experts have found that people with the common sleep disorder apnoea – which has hundreds of millions of sufferers worldwide – are five times likelier to develop atrial fibrillation.

They said that a number of people with apnoea, symptoms of which include stopping and starting breathing, making snorting noises, waking up a lot and loud snoring, can go undiagnosed, reports The Guardian.

The condition is already known to heighten the risk of serious health problems like high blood pressure, type 2 diabetes and depression, but now the US researchers have uncovered even more evidence about its impact on the heart, saying it significantly raises the risk of atrial fibrillation and stroke.

The findings were discussed by doctors at the annual meeting of the European Society of Cardiology, the world’s largest heart conference, in Amsterdam, reports The Guardian.

Studies involving experts from Stanford University looked at about 1.7m people aged 20 to 50 over a decade. Those with sleep apnoea were five times more likely to develop atrial fibrillation and 60% more likely to experience a stroke later in life, they found.

Sanjiv Narayan, a professor of cardiovascular medicine at Stanford and the study’s author, said: “We found a 60% increased risk of having a stroke if you have sleep apnoea.

The condition is really common but we tend to ignore it because we think it’s trivial or just a nuisance. Until now, no one’s really shown the magnitude of the size of the risk.

“That’s what really surprised us – and also this is in the relatively young.”

Sleep apnoea happens if your airways become too narrow while you sleep. This stops you breathing properly. Its causes are not always clear, but it has been linked to factors like obesity, having a large neck, smoking and drinking alcohol and sleeping on your back.

Atrial fibrillation causes an irregular and often abnormally fast heart rate.

Narayan said: “When you are unable to breathe, it raises the pressure in the lungs until you ultimately wake up gasping for breath.

“That puts a pressure load on the heart, which causes stretch in the heart chambers, and could cause the atrial fibrillation. Another theory could be that the oxygen levels in the blood fall for tens of seconds, which could put stress on the heart.”

Study details

Sleep apnea independently predicts incident atrial fibrillation in the young – Implications for targeted screening

B Deb, SK Vasireddi, NK Bhatia, AJ Rogers, P Clopton, SM Narayan.

Presented at ESC 2023 25-28 August 2023

Background
The risk factors predisposing to AF and ischaemic stroke are not well defined in the younger population. That said, routine screening for neither obstructive sleep apnoea (OSA) nor atrial fibrillation (AF) is recommended, although these risk factors comigrate. We hypothesised that OSA independently predicts AF in the young.

Methods
We mined electronic data from 2008 to 2022 from a large suburban academic and community healthcare system, for the endpoint of incident AF in 20-50Y adults. We related the endpoint to covariates including CHADSVASC components, OSA, race and socioeconomic factors prior to the diagnosis of AF, excluding patients with existing (prevalent) AF, haemorrhagic stroke, hypercoagulability and central sleep apnoea.

Results
From an overall population of 1.7m, we identified 765,645 aged 20-50Y. Of these, 7500 had OSA.  In the follow-up period, 4833 young individuals (45 per 100K person-years) experienced incident AF. Sleep apnoea [HR:5.16; (4.68, 5.68)] was the non-CHADSVASC strongest risk factor for incident AF, other than CKD [HR:3.74 (3.20,4.38)], Black race [HR:1.30 (1.16,1.46)], Hispanic ethnicity [HR:1.20; (1.10, 1.32)] and smoking [HR:1.32; (1.24, 1.41)]. Within CHADSVASC, other than heart failure [HR:10.23; (8.94,11.80)], all the other components had lower hazards than sleep apnoea. The C-index of CHADSVASC score is 0.51 which is augmented to 0.65 (P<0.05) with addition of OSA, CKD, race, ethnicity and smoking.

Conclusions
In a population of more than 700 000 20–50-year-old adults, sleep apnoea is a strong independent predictor for incident AF. This has implications for screening and therapy of young patients.

 

ESC presentation – Sleep apnoea independently predicts incident atrial fibrillation in the young – Implications for targeted screening (Restricted access)

 

The Guardian article – Sleep apnoea greatly increases risk of stroke, US scientists find

 

See more from MedicalBrief archives:

 

Active lifestyle may help protect against obstructive sleep apnea

 

Most AF triggers are easily modifiable lifestyle choices

 

Sleep apnoea link to memory loss and depression risk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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