Obstructive Sleep Apnea Treatment and Atrial Fibrillation Recurrence | Journal Scan

Apr 20, 2015
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Authors:
Shukla A, Aizer A, Holmes D, et al.
Citation:
Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence: A Meta-Analysis. JACC Clin Electrophysiol 2015;1:41-51.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the cumulative effect of treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) on atrial fibrillation (AF) recurrence?

Methods:

The investigators searched MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Trials Register for relevant studies. Evaluation of AF recurrence in CPAP users and nonusers in patients with OSA was the primary outcome evaluated in this study. The secondary outcome was evaluation of AF recurrence in CPAP users and nonusers after pulmonary vein isolation (PVI).

Results:

Seven prospective cohort studies with a total of 1,087 patients met the inclusion criteria. Across all patient groups, the use of CPAP was associated with a significant reduction in AF recurrence (relative risk, 0.58; 95% confidence interval, 0.51-0.67; heterogeneity chi-square p = 0.91, I2 = 0%). The beneficial effect of CPAP use was statistically significant in both groups of patients: those who underwent catheter ablation with PVI and those who did not undergo ablation and were managed medically. No other study covariates had any significant association with these outcomes of AF reduction.

Conclusions:

The authors concluded that use of CPAP is associated with significant reduction in recurrence of AF in patients with OSA.

Perspective:

This pooled analysis of studies suggests that use of CPAP in patients with OSA is associated with a significant reduction in recurrence of AF. The effect size remains consistent and similar across patient groups irrespective of whether the patients underwent PVI or were treated medically. Prospective randomized studies are indicated to understand the true efficacy and cost-effectiveness of CPAP, but meanwhile, it seems reasonable to promote use of CPAP in OSA patients with AF.

Keywords: Atrial Fibrillation, Catheter Ablation, Continuous Positive Airway Pressure, Prospective Studies, Pulmonary Veins, Recurrence, Risk, Sleep Apnea, Obstructive, Sleep Apnea Syndromes


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