Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment

Abstract

Data from nonrandomized studies of patients with AF suggest that treatment of OSA by continuous positive airway pressure may help to maintain sinus rhythm after electrical cardioversion and improve catheter ablation success rates. Randomized clinical trials are needed to confirm the association between OSA and AF the benefits of treatment of OSA and the need for and cost-effectiveness of routine OSA screening and treatment.

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

“…Lastly, since atrial enlargement has been previously identified as a risk factor for the recurrences, future studies with a large population are needed to assess the efficacy of CPAP on reversal the structural changes of the atrium, as an underlying mechanism reducing the risk for AF recurrence after ablation. Well‐designed RCTs are also required to address the impact and cost‐effectiveness of CPAP and AF recurrence after ablation …”

“…Continuous positive airway pressure (CPAP) is a well‐known, effective therapy for OSA. Several studies have demonstrated favorable effects of CPAP therapy on preventing arrhythmias recurrence, heart rate control in patients with AF, and in decreasing severity and/or frequency of ventricular extrasystoles Although the exact mechanism of CPAP use improves the success of AF treatment remains unclear, it has been suggested to be due to a reduction of the structural and electrical remodeling of the left atrium and oxidative stress, resulting in a lower recurrence rate of AF . Although the association between OSA and AF has been well established, it remains controversial whether patients with OSA carry a higher risk of recurrent AF after successful catheter ablation .…”

“…[1][2][3][4][5] The prevalence of OSA in populationbased studies ranges from 3% to 49% while the prevalence is AF c 2018 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd population is up to 21% to 74%. 3,6,7 Several potential mechanisms for OSA-induced AF have been proposed including intermittent hypoxemia and hypercapnia, sympathetically mediated vasoconstriction and surge in blood pressure during an apneic episode leading to left atrial (LA) enlargement, and atrial remodeling and fibrosis due to oxidative stress and inflammatory process. [8][9][10][11][12][13] A recent study on catheter ablation in AF patients suggested increasing proportion of patients with OSA undergoing catheter ablation for AF in the modern era cohort (2014)(2015) when compared with historic cohort (2009)(2010)(2011).…”

The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

“…It is well established that OSA contributes to the development of AF and a number of potential mechanisms have been proposed to explain the association such as intermittent hypoxia, recurrent arousals and increased negative intrathoracic pressure. 23 This can result in increased sympathetic nerve activity and oxidative stress, and possible electrical and mechanical remodelling of both atria and the left ventricle. 23 This is the first study to demonstrate improvement in AHI with long-term restoration of sinus rhythm confirmed with ICMs.…”

“…23 This can result in increased sympathetic nerve activity and oxidative stress, and possible electrical and mechanical remodelling of both atria and the left ventricle. 23 This is the first study to demonstrate improvement in AHI with long-term restoration of sinus rhythm confirmed with ICMs. Improving haemodynamic status and cardiac function with long-term restoration of SR could reduce fluid displacement from the lower limbs to the neck region of the body, a key mechanism in the pathogenesis of OSA.…”