Trends in Atrial Fibrillation-Related Mortality Among Older Adults With Obstructive Sleep Apnea in the United States, 1999-2020.

BACKGROUND

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist and synergistically increase cardiovascular risk. While their pathophysiologic interplay is well established, national data on mortality trends involving both conditions are scarce.

METHODS

We analyzed mortality data from the CDC WONDER platform (1999-2020), including adults aged ≥ 25 years with AF (ICD-10 I48.x) listed as the underlying cause of death and OSA (G47.33) as a contributing condition. Age-adjusted mortality rates (AAMRs) and average annual percent changes (AAPCs) were calculated using Joinpoint regression, stratified by sex, race/ethnicity, urbanization, region, and age.

RESULTS

A total of 32,142 AF-related deaths with OSA were identified. The overall AAMR was 0.60 per 100 000, increasing significantly over time (AAPC: 16.69%, 95% CI: 15.62-17.77). Mortality rose across all demographic groups, with the steepest increases among adults ≥ 85 years (AAPC: 19.40%), females (AAPC: 17.77%), rural residents (AAPC: 17.51%), and White individuals (AAPC: 16.95%). Regionally, the Midwest (AAMR: 0.79) and West (0.72) had the highest rates. State-level variation ranged from 1.90 (Oregon) to 0.19 (Mississippi). Despite lower absolute AAMRs among Hispanic and Asian populations, significant upward trends were observed. OSA appears frequently underdiagnosed or untreated in high-risk groups, potentially exacerbating AF mortality.

CONCLUSIONS

AF-related mortality involving OSA has risen sharply over the past two decades, outpacing many other cardiovascular trends. These findings underscore the urgent need for integrated AF-OSA screening and treatment pathways, with attention to underserved and disproportionately affected populations.