Is AFib Recurrence Lower With OSA Treatment?

The use of continuous positive airway pressure (CPAP) may be associated with “significant reduction in recurrence of atrial fibrillation (AFib) in patients with obstructive sleep apnea (OSA),” according to a study published April 20 in JACC: Clinical Electrophysiology. 

Researchers from the New York University Langone Medical Center in New York City performed a meta-analysis of seven studies including 1,087 patients to determine if CPAP reduced the recurrence of AFib in patients with OSA. 

Results showed that CPAP use was associated with a 42 percent relative risk reduction in AFib recurrence in patients with OSA regardless of their primary treatment. Specifically, the authors found that “the beneficial effect of CPAP use was statistically significant in both groups of patients: those who underwent catheter ablation with pulmonary vein isolation, and those who did not undergo ablation and were managed medically.”

The authors note that “these study findings are important as they provide the most conclusive evidence available and give the clinician an additional means to reduce AFib recurrence in patients with OSA.” They add that moving forward, “results from randomized controlled trials may be warranted to understand the true extent of its efficacy, [and] its use and adherence needs to be promoted aggressively in these patient groups.”

“Our study confirms the expanding body of evidence that treatment of modifiable risk factors has a significant impact on the long-term suppression of AFib regardless of the type of therapy offered,” said Larry A. Chinitz, MD, professor of medicine and cardiac electrophysiology at the New York University School of Medicine and one of the study authors. “Active screening for OSA in all patients who undergo treatment for AFib is imperative as the use of CPAP will influence the outcome of therapy and likely reduce some of the cardiovascular morbidity associated with AFib,” Chinitz adds. “Technology for home screening of sleep apnea needs to be made widely available and become as routine as measurements of blood pressure and blood sugar levels in diabetics.”

According to David J. Wilber, MD, FACC, editor-in-chief of JACC: Clinical Electrophysiology, “Sleep apnea, along with several other conditions including hypertension, obesity, and diabetes, actively contribute to the onset and progression of AFib. This study provides important evidence that we need to identify and treat these associated conditions if our more direct efforts to suppress the arrhythmia by antiarrhythmic drugs or ablation are to be effective.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension, Sleep Apnea

Keywords: Anti-Arrhythmia Agents, Atrial Fibrillation, Blood Glucose, Blood Pressure, Catheter Ablation, Continuous Positive Airway Pressure, Diabetes Mellitus, Electrophysiologic Techniques, Cardiac, Electrophysiology, Hypertension, Obesity, Pulmonary Veins, Research Personnel, Risk, Risk Factors, Sleep Apnea Syndromes, Sleep Apnea, Obstructive

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