Prevalence of Atrial Fibrillation among Individuals with Obstructive Sleep Apnea and Impact of Sleep Apnea on Incidence and Outcomes of Atrial Fibrillation: Systematic Review

Objective: This systematic review aims to evaluate the prevalence of AF in individuals with OSA and examine the impact of OSA on AF occurrence and outcomes. Methodology: A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, following PRISMA 2020 guidelines and The Cochrane Handbook. Studies were selected based on predefined inclusion and exclusion criteria, focusing on human observational studies examining the relationship between OSA and AF. The risk of bias was assessed independently by two reviewers, with a third reviewer resolving discrepancies. Results: Out of 200 initially identified studies, 37 met the relevance criteria, and 8 were ultimately included in the final analysis. The findings revealed a significant association between OSA and AF prevalence, with AF rates ranging from 7.2% to 49% in OSA patients, depending on the study population and OSA severity. Studies also indicated that OSA might contribute to AF development through mechanisms such as hypoxia, inflammation, and autonomic dysfunction. Furthermore, OSA was linked to a higher risk of AF recurrence post-treatment and increased hospitalization rates. Conclusions: The evidence suggests that OSA is an independent risk factor for AF, contributing to its development, recurrence, and worse clinical outcomes. Early identification and management of OSA, including continuous positive airway pressure (CPAP) therapy, may help mitigate AF-related risks. However, further large-scale prospective studies are needed to establish causal relationships and optimize treatment strategies. Key words: Atrial Fibrillation, Arrhythmia, Breathing, Cardiovascular, Obstructive Sleep Apnea, Sleep-disordered,