By Cardio

Obstructive sleep apnea (OSA) is a known predictor for onset and recurrence of atrial fibrillation (AF).

Ashish Shukla, MD, MPH, Anthony Aizer, MD, MSC, Douglas Holmes, MD, Steven Fowler, MD,
David S. Park, MD, PHD, Scott Bernstein, MD, Neil Bernstein, MD, Larry Chinitz, MD

Study objective

• This study aimed to evaluate the cumulative effect of treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) on atrial fibrillation (AF) recurrence.
• The primary outcome evaluated was AF recurrence in CPAP users and nonusers in patients with OSA. The secondary outcome evaluated was AF recurrence in CPAP users and nonusers following pulmonary vein isolation (PVI).

Methods

• The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar and the Cochrane Trial Registry for relevant studies.
• Systematic review of 452 relevant citations through June 2014 were identified with 18 potentially relevant articles retrieved. 7 studies went ultimately included in the analysis meeting the predetermined inclusion criteria with a cumulative total of 1,087 patients.

Limitations

The common limitations of meta-analysis. Risk of bias from the individual study, number of patients enrolled and publication bias were all identified but deemed to be of small risks.

Results

CPAP was associated with a significant reduction in atrial fibrillation (AF) recurrence (relative risk: 0.58, 95% confidence interval: 0.51 to 0.67; heterogeneity chi-square p ¼ 0.91, I2 ¼ 0%). The beneficial effect of CPAP use was statistically significant with both 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 atrial fibrillation (AF) reduction.

Key Takeaways

• The use of CPAP is associated with a 42% relative risk reduction in atrial fibrillation recurrence in patients with obstructed sleep apnea (OSA).

• This reduction of atrial fibrillation recurrence appears to be independent of medical or catheter ablation therapy and is consistent across patient groups with obstructed sleep apnea.

• These results advocate for active screening for undiagnosed obstructed sleep apnea in patients with atrial fibrillation when obstructed sleep apnea is clinically suspected For the full publication:
  Shulka, Chinitz et al. JACC: Clinical Electrophysiology, 2015. Vol. 1, No. 1-2