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Received Aug 31, 2017; Revised Dec 4, 2017; Accepted Dec 24, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice, affecting approximately 1% to 4% of the general population [1]. AF is associated with marked morbidity and increased mortality [1, 2]. It is reported that AF has also been associated with several disease processes such as hypertension, diabetes mellitus, heart failure, myocardial infarction, and valvular heart disease [3]. In recent years, there has been a growing interest about the link between sleep apnea hypopnea syndrome and atrial fibrillation (AF) [4]. Sleep apnea hypopnea syndrome (SAHS) is characterized by recurrent partial or complete collapse of upper airway during sleep and is estimated to affect approximately 5% of adult women and 14% of men [5]. It is reported that SAHS is common in the general population, especially among patients with established cardiovascular disease, including obesity, sedentary life, and increasing age [6]. Several studies have reported a higher prevalence of AF in patients with sleep apnea as compared with those without SAHS [7–9]. However, the conclusions of several observational studies are inconsistent with regard to AF risk. Six studies [3, 10–14] confirmed the link between SAHS and AF, while two studies [15, 16] failed to show any significant association between SAHS and AF.
Therefore, this study aims to conduct a meta-analysis by combining the results from all available cohort studies to examine whether SAHS increases AF incidence in common population and evaluate the risk of AF for mild SAHS (obstructive apnea hypopnea index, 5%–14.9%), moderate SAHS (obstructive apnea hypopnea index, 15%–29.9%), and severe SAHS (obstructive apnea hypopnea index, ⩾30), respectively.
2. Materials and Methods
2.1. Literature Search
The meta-analysis was performed based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines [17]. Two investigators independently performed a systematic literature search in any language on July 1, 2017, in EMBASE, PubMed, the Cochrane Library, and the Web of Science without limiting the publication date range. We used the following terms to identify relevant citations: (sleep apnea hypopnea...