Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence

Shukla, Ashish; Aizer, Anthony; Holmes, Douglas; Fowler, Steven J.; Park, David; Bernstein, Scott; Bernstein, Neil E.; Chinitz, Larry A.

doi:10.1016/j.jacep.2015.02.014

Cited by 108 publications

(61 citation statements)

References 32 publications

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“…They may be used for those who refuse or cannot tolerate CPAP and may provide an alternative to oral surgical intervention. At the very least, the patients found to be at high risk for OSA may be started on aggressive weight management therapy that can be very effective, even curative option for those who are overweight or obese [19]. Furthermore, educating patients with AF about the risks of untreated OSA may increase compliance with recommended therapy.…”

Section: Discussionmentioning

confidence: 99%

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Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

et al. 2019

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Background“There is a high prevalence of obstructive sleep apnea (OSA) among patients with atrial fibrillation (AF). There is also strong evidence that proper OSA management can reduce AF recurrence.” Polysomnography is the gold standard for OSA diagnosis, but screening tests, such as STOP-BANG, have been successful in identifying patients at risk for OSA. Our study assesses screening rates for OSA in patients with persistent AF, and willingness of patients at increased risk for OSA towards further diagnostic evaluation.MethodsA total of 254 persistent AF patients were surveyed regarding prior screening for OSA, and if previously unscreened, assessed with STOP-BANG. Prior cardioversions and willingness to undergo further workup was also recorded. Patients at risk for OSA were given educational brochures. Subjects with diagnosis of OSA were asked about their compliance with positive airway pressure therapy.ResultsSixty-six percent of AF patients were never screened for OSA; 75% unscreened participants (95% CI: 68-81%) were at high risk for OSA. Patients with previous hospitalizations or electrical cardioversions were more frequently screened for OSA (P = 0.02, P = 0.03, respectively). Forty-three percent of high-risk individuals had a BMI < 30. Among patients at risk for OSA (score ≥ 3), the majority (n = 99, 79%) were interested in follow-up with a sleep study (n = 93, 74%).ConclusionsAlthough there is a strong OSA-associated risk for AF, which is amenable to intervention, most patients with persistent AF are not assessed for OSA. Simple to use screening questionnaires are sensitive and can reliably identify patients at high risk for OSA, reserving costlier and somewhat inconvenient nocturnal polysomnography to only those at risk. We hope our study will help to push the AF and OSA connection into the spotlight in the primary care of patients with AF.

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Section: Discussionmentioning

confidence: 99%

“…The evidence of association is strengthened by the fact that treatment of OSA with continuous positive airway pressure (CPAP) has been shown to be effective in reducing recurrence of AF [16-18]. A recent meta-analysis showed that CPAP was associated with a 42% relative risk reduction in recurrence of AF [19].…”

Section: Introductionmentioning

confidence: 99%

Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

et al. 2019

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“…These findings suggest reversibility in the arrhythmogenic substrates induced by OSA by treatment with CPAP [ 21 ]. Data from meta-analyses have shown that patients with OSA have a 25-31% increased risk for AF recurrence after catheter ablation in comparison with patients with no sleep apnea [ 28 ]. Another meta-analysis performed by Qureshi et al [ 29 ] and Shukla et al [ 28 ] in 2015 demonstrated reductions in recurrence of AF after CPAP use.…”

Section: Reviewmentioning

confidence: 99%

“…Data from meta-analyses have shown that patients with OSA have a 25-31% increased risk for AF recurrence after catheter ablation in comparison with patients with no sleep apnea [ 28 ]. Another meta-analysis performed by Qureshi et al [ 29 ] and Shukla et al [ 28 ] in 2015 demonstrated reductions in recurrence of AF after CPAP use. In another meta-analysis by Li et al, the risk of recurrence of AF increased from 31% to 57% in patients with OSA not undergoing CPAP therapy [ 30 ].…”

Section: Reviewmentioning

confidence: 99%

The Converging Pathologies of Obstructive Sleep Apnea and Atrial Arrhythmias

Riaz

Bhatti

Sampat

et al. 2020

Cureus

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Obstructive sleep apnea (OSA) is highly prevalent in the United States (US). Along with epidemic rates of obesity, the rate of OSA cases is also on the rise. OSA is associated with multiple chronic health conditions, including hypertension, diabetes, stroke, myocardial ischemia, and heart rhythm disturbances. OSA is commonly treated with continuous positive airway pressure (CPAP) therapy. Several reports indicate that effective treatment of OSA can reduce the risk of cardiovascular diseases, including cardiac arrhythmias, especially atrial fibrillation (AF). CPAP therapy helps to maintain sinus rhythm after interventions such as electrical cardioversion and catheter ablation in patients with AF. However, more data is required to establish a relationship between OSA and other atrial arrhythmias as well to evaluate the effect of CPAP. This review will compile the latest evidence on the pathophysiology, management, and treatment of atrial arrhythmias associated with OSA.

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“…A. Shukla et al в 2015 г. провели метаанализ семи проспективных исследований, включивших 1087 пациентов с ФП и обструктивным апноэ сна, которым проводилась СРАР-терапия [36]. Пациенты были разделены на две группы: больные, которым выполняли изоляцию легочных вен и которые получали медикаментозную терапию.…”

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Obstructive sleep apnea and the risk of cardiovascular disease

Магомедова¹,

Golukhova²

2016

kreatkard

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; Голухова Елена Зеликовна, доктор мед. наук, профессор, академик РАН, заведующий отделением Обзор литературы посвящен взаимосвязи синдрома обструктивного апноэ сна и сердечно-сосудистых заболеваний. Описаны причины апноэ сна, механизм остановок дыхания во сне и возможные последствия этого расстройства. У пациентов с ишемической болезнью сердца, с нарушениями ритма сердца, артериальной гипертензией, ожирением нарушения дыхания во сне встречаются очень часто. Приведены данные о влиянии ночных апноэ на увеличение риска неблагоприятных сердечно-сосудистых событий. Анализ данных рандомизированных исследований показывает положительное влияние СРАР-терапии для лечения этой категории больных. Отмечено, что эффективность от лечения больше при более высокой приверженности пациентов к СРАР-терапии, увеличении длительности и сроков терапии. Продолжаются исследования, определяющие возможности при помощи терапии постоянным положительным давлением в дыхательных путях снижения риска возникновения инфаркта миокарда, нестабильной стенокардии, инсульта, нарушений ритма сердца, сердечной недостаточности, сахарного диабета у пациентов с обструктивным слип-апноэ. К л ю ч е в ы е с л о в а: синдром обструктивного апноэ сна; постоянное положительное давление в дыхательных путях; сердечно-сосудистые заболевания; ишемическая болезнь сердца.

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Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence

Abstract: The use of CPAP is associated with significant reduction in recurrence of AF in patients with OSA. This effect remains consistent and similar across patient populations irrespective of whether they undergo PVI.

Cited by 108 publications

References 32 publications

Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

The Converging Pathologies of Obstructive Sleep Apnea and Atrial Arrhythmias

Obstructive sleep apnea and the risk of cardiovascular disease

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