Continuous positive airway pressure (CPAP) was associated with a significant reduction in the recurrence of atrial fibrillation in patients with obstructive sleep apnea (OSA) who received pulmonary vein isolation (PVI) or medical management, a study found.
Researchers performed a meta-analysis of 7 observational studies or randomized, controlled trials of at least 6 months' duration in patients with atrial fibrillation and OSA that were published from 1966 to 2014. Results were published April 20 by the Journal of the American College of Cardiology: Clinical Electrophysiology.
In 5 of the 7 studies, patients had catheter ablation of atrial fibrillation with PVI; in the remaining 2 studies, atrial fibrillation was managed medically with methods including antiarrhythmic drugs. The PVI studies compared risk for atrial fibrillation recurrence in patients who received CPAP versus those who did not; the non-PVI studies compared atrial fibrillation recurrence among those who received CPAP and those who did not. Among the 1,087 patients included in the meta-analysis, those on CPAP had fewer recurrences of AF (186 of 557 [33.3%] vs. 308 of 530 [58.1%]; relative risk, 0.58; 95% CI, 0.51 to 0.67; P<0.001; heterogeneity chi-square P=0.91; I2=0%) regardless of their primary treatment. No other study covariates, such as hypertension, diabetes, coronary artery disease, left atrial dimension, or antiarrhythmic drug use, had any significant association with atrial fibrillation recurrence.
While a large randomized trial still needs to be done, the researchers believe the data show CPAP has potential to be a third treatment option for atrial fibrillation in addition to ablation and medical therapy, and these study findings provide the most conclusive evidence available and give the clinician an additional means to reduce atrial fibrillation recurrence.
“The physical discomfort associated with CPAP use is one of the key factors associated with its poor adherence in patients,” the authors wrote, “Thus, it becomes important to elucidate the mechanisms by which CPAP use may curb the proarrhythmic factors, as this could potentially pave the way for development of novel treatment algorithms for OSA.”