Impact of CPAP on the Atrial Fibrillation Substrate in Obstructive Sleep Apnea

Nalliah, C.; Wong, G.; Lee, Geoffrey; Voskoboinik, Aleksandr; Kee, Kirk; Goldin, Jeremy; Watts, Troy; Linz, Dominik; Sugumar, Hariharan; Prabhu, Sandeep; McLellan, A.; Ling, L.; Joseph, Stephen; Morton, Joseph B.; Kistler, P.; Sanders, Prashanthan; Kalman, Jonathan M.

doi:10.1016/j.jacep.2022.04.015

Cited by 22 publications

(16 citation statements)

References 26 publications

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“…In contrast to these three studies with negative outcomes, more promising results have been shown in the SLEEP-AF Study, an RCT that assessed the impact of CPAP therapy on the atrial substrate [52 ▪▪ ]. Twenty-four atrial fibrillation patients with moderate–severe OSA (AHI ≥15) were randomized to CPAP or no CPAP.…”

Section: Impact Of Continuous Positive Airway Pressure Therapy On Atr...mentioning

confidence: 92%

“…Based on this observational data, several cardiovascular society atrial fibrillation guidelines recommend consideration of treatment of OSA to improve atrial fibrillation outcomes [5,39,40]. However, more recently, several RCTs have not shown CPAP therapy to have an impact on atrial fibrillation burden [49,50,51 ▪▪ ], while another RCT has shown that CPAP can modulate the atrial substrate [52 ▪▪ ].…”

Section: Impact Of Continuous Positive Airway Pressure Therapy On Atr...mentioning

confidence: 99%

“…Compliance with CPAP therapy was high and resulted in significant AHI reduction (mean reduction: 31 ± 23 events/h). At follow-up, the CPAP group had faster conduction velocity, significantly higher voltages, lower proportion of complex points, and a trend toward lower proportion of atrial surface area, all indicating a reversal of atrial remodeling [52 ▪▪ ]. This study was limited in that atrial fibrillation burden was not assessed but does provide RCT evidence supporting CPAP therapy to modify the atrial substrate in atrial fibrillation patients with OSA.…”

Section: Impact Of Continuous Positive Airway Pressure Therapy On Atr...mentioning

confidence: 99%

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Obstructive sleep apnea in the patient with atrial fibrillation: current knowledge and remaining uncertainties

Lyons

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Obstructive sleep apnea (OSA) is highly prevalent in patients with atrial fibrillation and plays a causal role for OSA in the pathogenesis of atrial fibrillation. The presence of OSA in atrial fibrillation is associated with increased symptom burden and increased risk of hospitalizations. Furthermore, untreated OSA is associated with an increased risk of atrial fibrillation recurrence post ablation or cardioversion, and observational studies suggest that continuous positive airway pressure (CPAP) therapy can attenuate this risk. This review describes our current understanding of the relationship between OSA and atrial fibrillation with an emphasis on emerging evidence. Recent findings Recent studies have identified novel screening questionnaires, which may be superior to traditional questionnaires in identifying OSA in atrial fibrillation populations. Significant night-to-night variability in OSA severity has been shown in atrial fibrillation patients, which has implications for diagnostic testing. While several small, randomized control trials (RCTs) have not shown CPAP therapy to be effective in reducing atrial fibrillation burden, one RCT did show CPAP can attenuate the atrial substrate with implications for long-term outcomes. Summary Further RCTs, appropriately powered, and focused on well defined cohorts, are required to guide management decisions regarding screening and treatment of OSA in atrial fibrillation populations.

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Section: Impact Of Continuous Positive Airway Pressure Therapy On Atr...mentioning

confidence: 92%

Section: Impact Of Continuous Positive Airway Pressure Therapy On Atr...mentioning

confidence: 99%

Section: Impact Of Continuous Positive Airway Pressure Therapy On Atr...mentioning

confidence: 99%

See 1 more Smart Citation

Obstructive sleep apnea in the patient with atrial fibrillation: current knowledge and remaining uncertainties

Lyons

2023

Current Opinion in Pulmonary Medicine

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“…CPAP therapy appears to exert a benefic effect on ACM substrate. This concept is illustrated by the results of the SLEEP–AF study in which patients with AF and at least moderate OSA had improved parameters at electrophysiologic study after CPAP therapy compared to baseline electrophysiologic evaluation [ 101 ]. Similarly, another study showed that CPAP therapy is associated with improved LA function after 24 weeks of administration compared to baseline and sham CPAP [ 102 ].…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Ischemia with Nonobstructive Coronary Artery Disease and Atrial Cardiomyopathy—Two Sides of the Same Story?

Afrăsânie

Matei

Leancă

et al. 2023

Life

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Ischemia with nonobstructive coronary artery disease (INOCA) is increasingly recognized as a significant cause of angina, myocardial remodeling, and eventually heart failure (HF). Coronary microvascular dysfunction (CMD) is a major endotype of INOCA, and it is caused by structural and functional alterations of the coronary microcirculation. At the same time, atrial cardiomyopathy (ACM) defined by structural, functional, and electrical atrial remodeling has a major clinical impact due to its manifestations: atrial fibrillation (AF), atrial thrombosis, stroke, and HF symptoms. Both these pathologies share similar risk factors and have a high comorbidity burden. CMD causing INOCA and ACM frequently coexist. Thus, questions arise whether there is a potential link between these pathologies. Does CMD promote AF or the reverse? Which are the mechanisms that ultimately lead to CMD and ACM? Are both part of a systemic disease characterized by endothelial dysfunction? Lastly, which are the therapeutic strategies that can target endothelial dysfunction and improve the prognosis of patients with CMD and ACM? This review aims to address these questions by analyzing the existing body of evidence, offering further insight into the mechanisms of CMD and ACM, and discussing potential therapeutic strategies.

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“…The patient population may include a more advanced arrhythmogenic substrate of AF, even in the paroxysmal type. The SLEEP‐AF study revealed that CPAP therapy can be reversible in terms of the electrophysiological properties associated with AF promotion 57 . Therefore, CPAP therapy might be less effective in patients with more advanced structural remodeling.…”

Section: Management Of Sleep Apnea (Catheter Ablation Of Af and Osa)mentioning

confidence: 99%

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Iwasaki

2022

Journal of Arrhythmia

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Obstructive sleep apnea (OSA) is a highly prevalent disorder in patients with atrial fibrillation (AF). Although there has been an increase in the incidence of AF due to the aging population, it has been reported that OSA is still underdiagnosed because many patients remain asymptomatic or unaware of the symptoms associated with OSA, such as daytime sleepiness. Untreated OSA reduces the effectiveness of AF treatment, regardless of pharmacological or non‐pharmacological modes of therapy, such as catheter ablation. Experimental and clinical studies have shown that OSA pathophysiology is multifactorial, comprising of hypoxemia, hypercapnia, autonomic dysfunction, negative intrathoracic pressure changes, and arousals of OSA, and lead to AF. Both the acute and long‐term effects of obstructive apnea episodes are involved in the development of an arrhythmogenic substrate of AF. Undiagnosed OSA causes underutilized opportunities for more effective AF management. Therefore, it is important to screen for OSA in all patients being considered for rhythm control therapy. However, regardless of the growing evidence of the negative prognostic impact of OSA, there is a lack of awareness regarding this connection not only among patients but also among cardiologists and arrhythmia specialists. There is a barrier to performing a systemic screening for OSA in clinical practice. Therefore, it is important to establish a comprehensive OSA care team for the efficient diagnosis and treatment of OSA. This review provides the current understanding of OSA and its relationship to AF and the importance of the diagnosis and management of OSA in AF.

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Impact of CPAP on the Atrial Fibrillation Substrate in Obstructive Sleep Apnea

Cited by 22 publications

References 26 publications

Obstructive sleep apnea in the patient with atrial fibrillation: current knowledge and remaining uncertainties

Obstructive sleep apnea in the patient with atrial fibrillation: current knowledge and remaining uncertainties

Ischemia with Nonobstructive Coronary Artery Disease and Atrial Cardiomyopathy—Two Sides of the Same Story?

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

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