Key result
Long-term CPAP adherence linked to ~59% lower very late AF recurrence post-ablation in non-overweight severe OSA.
Why the study?
While CPAP therapy reduces AF recurrence after catheter ablation, the impact of CPAP adherence in non-overweight patients (BMI <25 kg/m²) with severe OSA remains unclear.
Does long-term CPAP adherence reduce very late recurrence of atrial fibrillation after catheter ablation in non-overweight patients with severe obstructive sleep apnea?
Does long-term CPAP adherence reduce very late recurrence of atrial fibrillation after catheter ablation in non-overweight patients with severe obstructive sleep apnea?
Sustained CPAP therapy improves long-term outcomes by reducing very late atrial fibrillation recurrence after catheter ablation in patients with severe OSA, regardless of whether they are overweight.
May support CPAP adherence to lower very late AF recurrence post-ablation in non-overweight severe OSA; hypothesis-generating and requires randomized confirmation.
Background Obstructive sleep apnea (OSA) is a common comorbidity in patients with atrial fibrillation (AF), and high body mass index (BMI) is a well-known risk factor for OSA. While continuous positive airway pressure (CPAP) therapy has been associated with reduced recurrence of AF following catheter ablation, the impact of CPAP adherence in non-overweight patients (BMI <25 kg/m²) with severe OSA remains unclear. Purpose This study aimed to investigate whether long-term CPAP adherence influences very late recurrence (VLR) of AF after catheter ablation in patients with severe OSA, specifically focusing on those with BMI <25 kg/m². Methods A total of 523 patients with severe OSA undergoing catheter ablation for AF were retrospectively analyzed. The cohort included 90 (17.2%) females, with a mean age of 65 ± 10 years and a mean BMI of 25.5 ± 3.6 kg/m². Of these, 242 patients (46.2%) had a BMI <25 kg/m². Patients were classified into two groups based on whether they maintained CPAP therapy for more than one year (long-term CPAP group). Recurrence rates were compared using Kaplan-Meier analysis, and multivariate Cox regression analysis was performed to assess the impact of CPAP adherence on VLR, adjusting for potential confounders. Results In patients with BMI <25 kg/m², the AF recurrence rate after the first ablation did not significantly differ between those with and without long-term CPAP adherence (log-rank p=0.20). In contrast, in patients with BMI ≥25 kg/m², long-term CPAP adherence was associated with a significantly lower recurrence rate (log-rank p=0.037). When evaluating VLR, the BMI <25 kg/m² group showed a trend toward lower recurrence with long-term CPAP (log-rank p=0.052). However, after adjusting for age, sex, non-paroxysmal AF, left atrial diameter, and hypertension in a multivariate analysis, long-term CPAP adherence was independently associated with a reduced risk of VLR in the BMI <25 kg/m² group (hazard ratio [HR]=0.41, 95% confidence interval [CI] 0.16–0.91, p=0.028). Conclusion(s) Long-term CPAP adherence is associated with a lower risk of very late AF recurrence even in non-overweight patients (BMI <25 kg/m²) with severe OSA. These findings emphasize the importance of sustained CPAP therapy in improving long-term outcomes after catheter ablation, regardless of BMI.
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N Tanaka (2025) studied this question. Long-term CPAP adherence reduced very late AF recurrence risk by 59% (HR=0.41) after catheter ablation in non-overweight severe OSA patients (BMI <25).
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