Impact of nocturnal hypoxemia on the recurrence of atrial tachyarrhythmia after catheter ablation of atrial fibrillation

Suzuki, Keisuke; Miyamoto, Koji; Wakamiya, Akinori; Ueda, Nobuhiko; Nakajima, Kenzaburo; Kamakura, Tsukasa; Wada, Mitsuru; Yamagata, Kenichiro; Ishibashi, Keiichiro; Inoue, Yuko; Noda, Takashi; Nagase, Satoshi; Aiba, Takeshi; Yambe, Tomoyuki; Kusano, Kengo

doi:10.1007/s00380-021-01969-x

Cited by 4 publications

(5 citation statements)

References 30 publications

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“…Five studies were not in the nal analysis because of the lacking of any sleep study to assess OSA. Finally, eight articles were included in our study for meta-analysis [13,[20][21][22][23][24][25][26]. Each article was evaluated thoroughly, and the quality of all the articles met the inclusion criteria.…”

Section: Search Resultsmentioning

confidence: 99%

“…The previous study showed that nocturnal hypoxia could increase the risk of major cardiovascular events by 34% [54]. And the indicators of hypoxia, such as the percentage of sleep time spent with SaO2 < 90% and mean fall in nocturnal SaO2 were associated with the recurrence of atrial brillation [22,25,31]. More studies are needed to explore the impact of OSA severity, OSA clinical subtypes, and CPAP usage on the treatment effect of AF.…”

Section: Discussionmentioning

confidence: 99%

“…The duration of the follow-up ranged from 12 to 32 months. 4 of the 12 studies had mentioned the application time of nightly CPAP use, and the CPAP therapy in these four studies was all well-compliant (more than 4 hours per night) [13,25,27,28]. The diagnostic criterion for OSA was based on AHI, and all but two studies by Patel, D. [20] and Fein, A. S.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The main characteristics of the eight studies and the 1372 patients are listed in Tables 2 and 3. Totally, there were 6 observational studies [20][21][22][23]25,26] and 2 RCTs [13,24]. The duration of the follow-up ranged from 12 to 32 months.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Wang

Luo

Huang

et al. 2022

Preprint

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Background: A higher incidence of atrial fibrillation is linked to obstructive sleep apnea. The effects of continuous positive airway pressure on atrial fibrillation have been studied in observational studies and randomized controlled trials. We conducted this meta-analysis to assess the effect of continuous positive airway pressure therapy on the recurrence of atrial fibrillation after conversion to sinus rhythm in obstructive sleep apnea patients. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane, and Web of Science databases from inception till October 2022. We included cohort studies and randomized controlled trials containing the recurrent situation of atrial fibrillation after catheter ablation or direct current cardioversion with and without continuous positive airway pressure therapy. The random-effects model was used to evaluate the odds ratios (OR) and confidence intervals (CI). I2 was used to assess the heterogeneity. Results: 8 studies with a total of 1372 obstructive sleep apnea patients met the inclusion criteria. Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 57% (OR=0.43, 95% CI 0.29-0.64, I2=38.0%). Subgroup analysis showed that the protective effect was more significant in groups with a higher burden of atrial fibrillation (OR 0.294 vs. 0.622, 95% CI 0.164-0.524 vs. 0.376-1.027, p=0.055) and with more hypertension patients (OR 0.272 vs. 0.550, 95% CI 0.165-0.449 vs. 0.329-0.922, p=0.054). Age, body mass index, severity of OSA, and therapy compliance had no significant effect on the recurrence of atrial fibrillation. Conclusions: Continuous positive airway pressure therapy decreased the atrial fibrillation recurrence rate. The severity of atrial fibrillation and hypertension both had an impact on it. Studies focused on the effects of the severity of OSA and treatment compliance, and more randomized controlled trials are needed in the future.

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Section: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Wang

Luo

Huang

et al. 2022

Preprint

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“… 20 While population‐based and clinical cohort data implicate SDB in AF development, the role of sleep‐related hypoxia in AF evolution and risk remains inconsistent. 17 , 21 , 22 , 23 , 24 Sleep study–derived hypoxia metrics that take desaturation characteristics into account 25 , 26 , 27 , 28 have been used, but whether these truly reflect SDB‐specific hypoxia has been an area of inquiry. 29 Specifically, lung restriction as a plausible cause of hypoxia in patients with SDB, perhaps as a result of visceral adiposity from obesity, 30 , 31 has yet to be taken into consideration in existing published data examining hypoxia metrics in relation to AF.…”

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confidence: 99%

Sleep‐Disordered Breathing, Hypoxia, and Pulmonary Physiologic Influences in Atrial Fibrillation

Heinzinger,

Thompson,

Milinovich

et al. 2023

JAHA

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Background We leverage a large clinical cohort to elucidate sleep‐disordered breathing and sleep‐related hypoxia in incident atrial fibrillation (AF) development given the yet unclear contributions of sleep‐related hypoxia and pulmonary physiology in sleep‐disordered breathing and AF. Methods and Results Patients who underwent sleep studies at Cleveland Clinic January 2, 2000, to December 30, 2015, comprised this retrospective cohort. Cox proportional hazards models were used to examine apnea hypopnea index, percentage time oxygen saturation <90%, minimum and mean oxygen saturation, and maximum end‐tidal carbon dioxide on incident AF adjusted for age, sex, race, body mass index, cardiopulmonary disease and risk factors, antiarrhythmic medications, and positive airway pressure. Those with spirometry were additionally adjusted for forced expiratory volume in 1 second, forced vital capacity, and forced expiratory volume in 1 second/forced vital capacity. This cohort (n=42 057) was 50.7±14.1 years, 51.3% men, 74.1% White individuals, had median body mass index 33.2 kg/m 2 , and 1947 (4.6%) developed AF over 5 years. A 10‐unit apnea hypopnea index increase was associated with 2% higher AF risk (hazard ratio [HR], 1.02 [95% CI, 1.00–1.03]). A 10‐unit increase in percentage time oxygen saturation <90% and 10‐unit decreases in mean and minimum oxygen saturation were associated with 6% (HR, 1.06 [95% CI, 1.04–1.08]), 30% (HR, 1.30 [95% CI, 1.18–1.42]), and 9% (HR, 1.09 [95% CI, 1.03–1.15]) higher AF risk, respectively. After adjustment for spirometry (n=9683 with available data), only hypoxia remained significantly associated with incident AF, although all coefficients were stable. Conclusions Sleep‐related hypoxia was associated with incident AF in this clinical cohort, consistent across 3 measures of hypoxia, persistent after adjustment for pulmonary physiologic impairment. Findings identify a strong role for sleep‐related hypoxia in AF development without pulmonary physiologic interdependence.

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Sleep Apnea Physiological Burdens and Cardiovascular Morbidity and Mortality

Labarca,

Vena,

et al. 2023

Am J Respir Crit Care Med

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Impact of nocturnal hypoxemia on the recurrence of atrial tachyarrhythmia after catheter ablation of atrial fibrillation

Cited by 4 publications

References 30 publications

Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Sleep‐Disordered Breathing, Hypoxia, and Pulmonary Physiologic Influences in Atrial Fibrillation

Sleep Apnea Physiological Burdens and Cardiovascular Morbidity and Mortality

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