TOPLINE

A real-world study found that sleep apnoea was independently associated with a more than threefold increased risk for new-onset atrial fibrillation in patients undergoing maintenance peritoneal dialysis (PD), with the highest risk observed in those older than 60 years with sleep apnoea.

METHODOLOGY

• Researchers conducted a real-world retrospective study to assess the incidence, risk factors, and adverse outcomes of new-onset atrial fibrillation in 401 patients (median age, 64 years; 256 men) undergoing maintenance PD for more than 30 days between 2009 and 2019.
• The median duration of PD was 1.6 years, corresponding to 850 patient-years of follow-up.
• The primary outcome was the incidence of new-onset atrial fibrillation during PD, verified through ECG, telemetry monitoring, or pacemaker logs; secondary outcomes were the occurrence of electrical direct current cardioversion, ischaemic non-haemorrhagic strokes, and mortality during PD.
• Sleep apnoea was diagnosed with polysomnography in the hospital or at home; coronary artery disease (CAD) was defined as clinical records of CAD, myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting.

TAKEAWAY

• New-onset atrial fibrillation occurred in 46 (13.6%) out of 337 patients without prior atrial fibrillation during PD, with an incidence rate of 6.3 per 100 patient-years.
• Sleep apnoea was independently associated with an approximately threefold increased risk for new-onset atrial fibrillation during PD (adjusted hazard ratio [aHR], 3.182; P = .006). The risk was highest among patients older than 60 years with sleep apnoea (aHR, 5.496; P < .001). 
• Increasing age (aHR, 1.061; P < .001) and CAD (aHR, 2.062; P = .021) were also independently associated with an increased risk for new-onset atrial fibrillation during PD. 
• No significant association was found between new-onset atrial fibrillation during PD and the incidence of stroke or mortality during PD. 

IN PRACTICE

"We observed an independent association between NOAF [new-onset atrial fibrillation] and sleep apnea in patients receiving maintenance PD and the risk of NOAF during PD was as high as 50% in patients older than 60 years with a prior diagnosis of sleep apnea signifying the weight of these risk factors in this population," the authors wrote.

SOURCE

This study was led by Jonna Virtanen, Turku University Hospital and University of Turku, Turku, Finland. It was published online on August 18, 2026, in BMC Nephrology.

LIMITATIONS

The sample size was relatively small, and the median duration of PD was short. No systematic screening for new-onset atrial fibrillation was performed, and data on the episode duration or the proportion of symptomatic vs asymptomatic episodes were lacking. Additionally, information on certain potentially confounding factors, such as BMI, volume overload, residual kidney function, and echocardiographic findings, was not available.

DISCLOSURES

This study was supported by grants from the Finska Läkaresällskapet, Helsinki, Finland. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.