Key result
Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 57% (OR 0.43; 95% CI 0.29-0.64) in patients with obstructive sleep apnea.
Why the study?
A higher incidence of atrial fibrillation is linked to obstructive sleep apnea, but the effect of continuous positive airway pressure therapy on recurrence after conversion to sinus rhythm required evaluation.
Does continuous positive airway pressure therapy reduce the recurrence of atrial fibrillation in obstructive sleep apnea patients after conversion to sinus rhythm?
Meta-Analysis (n=1,372)
Does continuous positive airway pressure therapy reduce the recurrence of atrial fibrillation in obstructive sleep apnea patients after conversion to sinus rhythm?
Continuous positive airway pressure therapy significantly reduces the recurrence of atrial fibrillation in patients with obstructive sleep apnea following conversion to sinus rhythm, with greater benefit seen in those with higher AF burden and hypertension.
Supports CPAP consideration in AF with OSA to lower recurrence; confirms benefit in Level 1 meta-analysis.
Aim: A higher incidence of atrial fibrillation is linked to obstructive sleep apnea. The effects of continuous positive airway pressure on atrial fibrillation have been studied in observational studies and randomized controlled trials. We conducted this meta-analysis to assess the effect of continuous positive airway pressure therapy on the recurrence of atrial fibrillation after conversion to sinus rhythm in obstructive sleep apnea patients. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane, and Web of Science databases from inception till October 2022. We included cohort studies and randomized controlled trials containing the recurrent situation of atrial fibrillation after catheter ablation or direct current cardioversion with and without continuous positive airway pressure therapy. The random-effects model was used to evaluate the odds ratios (OR) and confidence intervals (CI). I 2 was used to assess the heterogeneity. Results: 8 studies with a total of 1372 obstructive sleep apnea patients met the inclusion criteria. Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 57% (OR=0.43, 95% CI 0.29-0.64, I 2 =38.0%). Subgroup analysis showed that the protective effect was more significant in groups with a higher burden of atrial fibrillation (OR 0.294 vs. 0.622, 95% CI 0.164-0.524 vs. 0.376-1.027, p=0.055) and with more hypertension patients (OR 0.272 vs. 0.550, 95% CI 0.165-0.449 vs. 0.329-0.922, p=0.054). Age, body mass index, severity of OSA, and therapy compliance had no significant effect on the recurrence of atrial fibrillation. Conclusion: Continuous positive airway pressure therapy decreased the atrial fibrillation recurrence rate. The severity of atrial fibrillation and hypertension both had an impact on it. Studies focused on the effects of the severity of OSA and treatment compliance, and more randomized controlled trials are needed in the future.
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Xiao et al. (2022) conducted a meta-analysis in Obstructive sleep apnea and atrial fibrillation (n=1,372). Continuous positive airway pressure therapy vs. Without continuous positive airway pressure therapy was evaluated on Recurrence of atrial fibrillation (OR 0.43, 95% CI 0.29-0.64). Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 57% (OR 0.43; 95% CI 0.29-0.64) in patients with obstructive sleep apnea.
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