{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:12:37Z","timestamp":1784214757528,"version":"3.55.0"},"reference-count":50,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed mortality data from the CDC WONDER platform (1999\u20132020), including adults aged \u2265\u200925 years with AF (ICD\u201010 I48.x) listed as the underlying cause of death and OSA (G47.33) as a contributing condition. Age\u2010adjusted mortality rates (AAMRs) and average annual percent changes (AAPCs) were calculated using Joinpoint regression, stratified by sex, race\/ethnicity, urbanization, region, and age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 32,142 AF\u2010related deaths with OSA were identified. The overall AAMR was 0.60 per 100\u2009000, increasing significantly over time (AAPC: 16.69%, 95% CI: 15.62\u201317.77). Mortality rose across all demographic groups, with the steepest increases among adults \u2265\u200985 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\u2010level 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\u2010risk groups, potentially exacerbating AF mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>AF\u2010related 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\u2010OSA screening and treatment pathways, with attention to underserved and disproportionately affected populations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.70178","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T10:39:08Z","timestamp":1752575948000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Trends in Atrial Fibrillation\u2010Related Mortality Among Older Adults With Obstructive Sleep Apnea in the United States, 1999\u20132020"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3331-8138","authenticated-orcid":false,"given":"Ibrahim Nagmeldin","family":"Hassan","sequence":"first","affiliation":[{"name":"University of Khartoum Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Al\u2010Neelain University Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddig","family":"Yaqub","sequence":"additional","affiliation":[{"name":"Karary University, Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhsin","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Sudan University of Science and Technology, Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haythem","family":"Abdalla","sequence":"additional","affiliation":[{"name":"University of Bahri, Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada","family":"Aljaili","sequence":"additional","affiliation":[{"name":"Omdurman Islamic University, Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafa","family":"Osman","sequence":"additional","affiliation":[{"name":"University of Bahri, Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagmeldin","family":"Abuassa","sequence":"additional","affiliation":[{"name":"University of Khartoum Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Allama Iqbal Medical College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Shoukat","sequence":"additional","affiliation":[{"name":"Gujranwala Medical College Gujranwala Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.020163"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws342"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.86.s1.03"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.12.009"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.0095"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2023.09.012"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.03.052"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00668"},{"key":"e_1_2_14_10_1","unstructured":"Centers for Disease Control and Prevention. 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