Meta-Analysis of Continuous Positive Airway Pressure as a Therapy of Atrial Fibrillation in Obstructive Sleep Apnea

Qureshi, W., Nasir, U., Algalyoobi, S., O’Neal, W., Mawri, S., Sabbagh, S., Soliman, E., Al-Mallah, M.

Am J Cardiol 2015; 116:1767-1773.

PMID: 26482182

       Atrial Fibrillation (AF) is a significantly health care problem for patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) as a therapy for OSA is underused, and it is unknown if CPAP might reduce rates of AF. We systematically reviewed the published reports on CPAP use and risk of AF.

         The present study systematically reviewed the published reports on CPAP use and risk of AF. MEDLINE, EMBASE, CINAHL, Web of Science, meeting abstracts, and Cochrane databases were searched from inception to June 2015. Studies need to report the rates of AF in participants who were and were not on CPAP. Data were extracted by 2 authors. A total of 8 studies on OSA were identified (1 randomized controlled trial) with 698 CPAP users and 549 non-CPAP users. The 8 studies were published between 2003 and 2013 and included a total of 4,516 participants with AF who underwent catheter ablation. Of these, 1,247 patients were diagnosed with OSA and 698 were treated with CPAP. Recurrence of AF was considered as the outcome measure. AF recurrence in 125 (18%) participants who used CPAP and 205 (37%) participants who did not. The mean ages of the participants ranged from 50 to 66 years, and most were men. In a random effects model, patients treated with CPAP had a 42% decreased risk of AF (pooled risk ratio: 0.58; 95% CI: 0.47 to 0.70; p < 0.001). There was low heterogeneity in the results (I2=30%). In metaregression analysis, benefits of CPAP were stronger for younger, obese, and male patients (p< 0.05). An inverse relationship between CPAP therapy and AF recurrence was observed.

         Results suggest that more patients with AF also should be tested for OSA.

Future implications: The population-attributable risk for CPAP use for recurrent AF was -17%. This means that based on the population of AF CPAP users who had AF (35%) in the included studies and RR of 0.58, use of CPAP might have prevented 17% of cases of recurrent AF in patients with OSA. Patients were heterogeneous although the overall results were consistent. OSA was not examined by severity because that information was not available for all patients.

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