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Observational Study
. 2017 Sep;21(3):601-606.
doi: 10.1007/s11325-017-1469-6. Epub 2017 Feb 2.

Stratification of cardiovascular risk in patients with atrial fibrillation and obstructive sleep apnea-validity of the 2MACE score

Anna E Platek  1 , Filip M Szymanski  2 , Krzysztof J Filipiak  2 , Alicja Dudzik-Plocica  2 , Bartosz Krzowski  2 , Grzegorz Karpinski  2
Affiliations
Observational Study

Stratification of cardiovascular risk in patients with atrial fibrillation and obstructive sleep apnea-validity of the 2MACE score

Anna E Platek et al. Sleep Breath. 2017 Sep.

Abstract

Background: Risk stratification in patients with atrial fibrillation (AF) is critically important because this group is at high risk of mortality and morbidity. One of the comorbidities potentially affecting thromboembolic and total cardiovascular risk is obstructive sleep apnea (OSA). The aim of this study was to determine whether or not patients with atrial fibrillation and concomitant obstructive sleep apnea have a higher predicted cardiovascular risk than those without sleep-disordered breathing.

Methods: The study was designed to be a cross-sectional observational study. Consecutive patients with primary diagnosis of AF who qualified for first-ever catheter ablation between 2011 and 2013 were enrolled. All patients had an overnight polysomnography performed for the diagnosis of OSA and calculation of a 2MACE score-a cardiovascular risk assessment score for AF.

Results: We studied 211 AF patients (mean age 57.1 ± 10.2 years, 62.6% males). OSA with apnea-hypopnea index (AHI) ≥15/h was found in 48 patients (22.7%). Cardiovascular disease and risk factors were as follows: 8 (3.8%) patients had congestive heart failure, 27 (12.8%) diabetes, 16 (7.6%) history of stroke or thromboembolic disease, 194 (91.9%) arterial hypertension, 24 (11.4%) vascular disease, and 31 (14.7%) were current smokers. A significantly higher percentage of patients with OSA was at high risk of cardiovascular disease (29.2 vs. 8.1%; p < 0.0001). The trend remained significant in different categories of obstructive sleep apnea when categorized by AHI into non-OSA, and mild, moderate, and severe OSA. Similarly, the mean 2MACE score was statistically significantly higher in OSA than non-OSA patients (2.1 ± 1.1 vs. 1.4 ± 1.0; p < 0.0001).

Conclusion: OSA prevalence is increased in AF patients and is associated with an increase 2MACE score-an indicator of major cardiovascular events. There is a linear relationship between severity of OSA and increasing 2MACE scores, indicating increasing cardiovascular risk related to OSA severity.

Keywords: Cardiovascular risk; Obstructive sleep apnea; Risk assessment.

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Conflict of interest statement

Funding

No funding was received for this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Percentage of patients with high cardiovascular risk in the 2MACE score according to the severity of obstructive sleep apnea
Fig. 2
Fig. 2
Mean 2MACE score according to the severity of obstructive sleep apnea
Fig. 3
Fig. 3
Relationship between 2MACE score and OSA index in patients with different body mass index
See this image and copyright information in PMC

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