Improvement in the severity of sleep disordered breathing three months after pulmonary vein isolation in patients with persistent atrial fibrillation

Introduction Sleep-disordered breathing (SDB) is common in patients with atrial fibrillation (AF), and its treatment reduces AF recurrence after pulmonary vein isolation (PVI). However, research examining the impact of sinus rhythm restoration through PVI on SDB is limited. We previously reported that the apnea-hypopnea index (AHI) improved one week after the ablation of AF. However, the mid-term impact of sinus rhythm restoration on SDB remains unclear. Purpose We aimed to assess the effect of sinus restoration by PVI on SDB in patients with persistent AF 3 months after the ablation. Methods We retrospectively analyzed 31 patients (mean age 67 ± 9 years; 27 men) with persistent AF who underwent PVI. The AHI was measured before and 3 months after PVI using type 3 polysomnography. Results At 3 months post-PVI, median AHI significantly decreased from 31.0 (interquartile range [IQR] 15.5–42.4) to 22.0 (IQR 9.7–35.9) (P = 0.027). AHI improved in 68% of patients, with 48% exhibiting a reduction in SDB severity. Median left atrial volume (151 [132–169] ml to 116 [91–140] ml; p<0.001) and NT-proBNP levels (751 [IQR 436–1050] pg/ml to 238 [132–425] pg/ml; p<0.001) also significantly declined. These reductions were independently associated with AHI improvement (odds ratio [OR] 3.875 [95% confidence interval 2.065–6.357; p<0.001] for atrial volume; OR 6.410 [95% confidence interval 1.148–8.714]; p<0.001 for NT-proBNP). During a median follow-up of 12.9 months, AF recurrence was significantly lower in the AHI-improved group (log-rank P = 0.023). Conclusion Our findings suggest that PVI contributes not only to rhythm control but also to improvement in SDB, likely through structural and hemodynamic changes. Assessing SDB after PVI under sinus rhythm may be important for comprehensive AF management.