Documented Obstructive Sleep Apnea, Cardiometabolic Phenotype, and Rhythm‐Related Outcomes After Atrial Fibrillation Ablation: An Observational Cohort Study

ABSTRACT Background Obstructive sleep apnea syndrome (OSAS) is common in atrial fibrillation (AF) and may influence AF phenotype and post‐ablation recurrence. We aimed to determine whether documented OSAS identifies a distinct clinical phenotype and whether it is associated with post‐ablation rhythm‐related outcomes. Methods We performed a single‐center observational study with two overlapping cohorts. The principal registry cohort comprised 2559 patients with first AF ablation with pulmonary vein isolation (PVI) treated between November/2021 and July/2025. Its primary endpoint was the same‐center rhythm‐intervention endpoint, defined as the first post‐index repeat PVI or electrical cardioversion at the study center. A 7‐day Holter was scheduled 90 days after ablation. The nested active 2022 cohort comprised 666 AF/PVI patients. Results Documented OSAS was present in 268 of 2559 registry patients, 10.5%, and in 66 of 652 patients with known OSAS status in the active subset, 10.1%. Documented OSAS was associated with higher BMI, more obesity, hypertension, diabetes, persistent AF, higher triglycerides and liver enzymes, and lower HDL cholesterol. In the registry cohort, the same‐center rhythm‐intervention endpoint occurred in 59/268 patients with documented OSAS (22.0%) and 521/2291 without documented OSAS (22.7%; p = 0.788). Documented OSAS was not associated with the registry endpoint after adjustment (OR: 0.87, 95% CI: 0.63–1.21; p = 0.411). In the active 2022 cohort, recurrence occurred in 16/32 patients with documented OSAS (50.0%) and 167/302 without documented OSAS (55.3%; p = 0.581). Adjusted Cox analysis also showed no independent documented OSAS (HR: 1.08, 95% CI: 0.61–1.94; p = 0.786). Conclusion Documented OSAS identified an adverse cardiometabolic AF ablation phenotype but was not independently associated with same‐center rhythm interventions.