Incidence of Arrhythmias in Chronic Obstructive Pulmonary Disease, Obstructive Sleep Apnea and Overlap Syndrome: A Retrospective Cohort Study

Background: New-onset arrhythmias are common in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). However, scarce data exists regarding arrhythmia risk in overlap syndrome (OS), encompassing COPD and OSA.

Objective: We compared the incidence of new onset atrial and ventricular arrhythmias in patients with COPD, OSA, and OS.

Methods: We conducted a retrospective cohort study using the TriNetX Network, comprising >140 million patients to identify patients with COPD, OSA, and OS. Patients with pre-existing arrhythmias were excluded. Propensity score matching (PSM) was used to adjust for demographics, comorbidities, and medications. Adjusted odds ratios (aORs) were estimated to compare incidence of arrhythmias across cohorts.

Results: Between 2010-2020, a total of 2,438,454 patients with COPD-only, 1,960,845 with OSA-only, and 440,018 with OS (age≥18 years) were identified. After PSM, we included 359,496 patients per cohort for the OS versus OSA-only comparison and 399,235 patients per cohort for the OS versus COPD-only comparison. Over a mean follow-up of 5.3 years, new-onset atrial fibrillation/flutter incidence was 10.0% in OS vs. 7.0% in COPD (aOR 1.472, 95%CI 1.449-1.496) and 6.4% in OSA (aOR 1.568, 95%CI 1.541-1.595). Patients with OS had higher incidence of new-onset ventricular tachycardia and cardiac arrest than those with COPD (aOR 1.442 and 1.189, respectively) and OSA (aOR 1.645 and 1.777, respectively). Patients with COPD preceding OSA diagnosis had higher odds of new-onset arrhythmias.

Conclusion: Patients with OS have a higher incidence of new-onset atrial fibrillation/flutter, ventricular tachycardia, and cardiac arrest compared to those with OSA and COPD alone.