Correlation of glycemic variability with the risk of atrial fibrillation and in-hospital mortality in patients diagnosed with obstructive sleep apnea: a retrospective study based on the Medical Information Mart for Intensive Care database

Background: Obstructive sleep apnea (OSA) has seen a rising prevalence and is closely linked with various cardiovascular diseases. Fluctuations in blood sugar levels, known as glycemic variability (GV), are linked to negative cardiovascular outcomes. The objective of this research is to explore how fluctuations in blood sugar levels affect the occurrence of atrial fibrillation (AF) and the rate of mortality during hospitalization in individuals with OSA. Methods: This study conducted a retrospective analysis of patients diagnosed with OSA based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (version 2.2) covering the 2008-2019 period. The relationship between GV and outcomes such as AF and in-hospital mortality was assessed through restricted cubic spline (RCS) models and logistic regression (LR), with AF and in-hospital mortality as the primary endpoints. The differences in the risk of AF and in-hospital mortality across various levels of GV were examined using Kaplan-Meier (K-M) survival analysis. Additionally, subgroup analyses were performed to further explore these correlations. Results: The research involved 6,189 individuals, with a mean age of 64 years old, 36% of whom were women. Among the cohort, 176 patients (2.8%) died during hospitalization, and 673 patients developed AF in the hospital. The analysis using LR revealed a notable link between the GV index and both the risk of AF and in-hospital mortality among OSA patients. According to the RCS model, there was a clear dose-response relationship, revealing that higher values of the GV index corresponded to a heightened risk of AF and in-hospital mortality. Moreover, analysis using the K-M method showed that there were notable statistical variations in the risks of AF and mortality among OSA patients, stratified by quartiles of the GV index. Conclusions: Patients with OSA who have an elevated GV index face a significantly higher risk of both AF and mortality during hospitalization, underscoring the importance of developing personalized glycemic management strategies to improve patient outcomes.