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

Qureshi, Waqas; Nasir, Usama; Alqalyoobi, Shehabaldin; O’Neal, Wesley T.; Mawri, Sagar; Sabbagh, Salah; Soliman, Elsayed Z; Al-Mallah, Mouaz

doi:10.1016/j.amjcard.2015.08.046

Cited by 151 publications

(83 citation statements)

References 32 publications

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“…The SPOSA is a weighted model containing comorbidity and demographic variables known to be associated with OSA, including: chronic pulmonary disease [35], congestive heart failure [5, 6], diabetes [7], dyslipidemia [36, 37], hypertension [3, 38], atrial fibrillation [39, 40], liver disease [41], coronary artery disease [42], and pulmonary hypertension [43, 44]. The association between hemiplegia/paraplegia and OSA may be related to the an association between OSA and acute ischemic stroke [4, 45].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

et al. 2017

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BackgroundPostoperative respiratory complications (PRCs) are associated with significant morbidity, mortality, and hospital costs. Obstructive sleep apnea (OSA), often undiagnosed in the surgical population, may be a contributing factor. Thus, we aimed to develop and validate a score for preoperative prediction of OSA (SPOSA) based on data available in electronic medical records preoperatively.MethodsOSA was defined as the occurrence of an OSA diagnostic code preceded by a polysomnography procedure. A priori defined variables were analyzed by multivariable logistic regression analysis to develop our score. Score validity was assessed by investigating the score’s ability to predict non-invasive ventilation. We then assessed the effect of high OSA risk, as defined by SPOSA, on PRCs within seven postoperative days and in-hospital mortality.ResultsA total of 108,781 surgical patients at Partners HealthCare hospitals (2007–2014) were studied. Predictors of OSA included BMI >25 kg*m−2 and comorbidities, including pulmonary hypertension, hypertension, and diabetes. The score yielded an area under the curve of 0.82. Non-invasive ventilation was significantly associated with high OSA risk (OR 1.44, 95% CI 1.22–1.69). Using a dichotomized endpoint, 26,968 (24.8%) patients were identified as high risk for OSA and 7.9% of these patients experienced PRCs. OSA risk was significantly associated with PRCs (OR 1.30, 95% CI 1.19–1.43).ConclusionSPOSA identifies patients at high risk for OSA using electronic medical record-derived data. High risk of OSA is associated with the occurrence of PRCs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0361-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

et al. 2017

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“…In a meta-analysis (57) of 698 CPAP users and 549 non-CPAP users, those with OSA treated with CPAP after AF intervention had a 44% reduced AF risk; younger, more obese, and male patients benefited the most. On the basis of this evidence, a recent expert consensus document on AF identified OSA as a risk factor for AF recurrence after surgical and catheter ablation, and recommended its treatment (58).…”

Section: Osa and Related Cvd: Effect Of Cpap Therapymentioning

confidence: 99%

Sleep Apnea

Javaheri

Barbé

Campos‐Rodríguez

et al. 2017

Journal of the American College of Cardiology

897

262

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Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.

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“…Several pathophysiologic mechanisms may contribute to the relationship between OSA and atrial fibrillation: sudden and repeated swings in intra-thoracic pressure, structural remodeling of the left atrium over time, systemic inflammation, and instability of autonomic tone associated with intermittent hypoxia or hypercapnia (Hohl et al 2014;Orban et al 2008;Neilan et al 2013;Stevenson et al 2010). In non-surgical OSA patients, PAP treatment reduces or abolishes hypopnea and apnea episodes, reverses cardiac remodeling, mitigates systemic inflammation and reduces atrial fibrillation recurrence risk in patients with prior atrial fibrillation history (Qureshi et al 2015;Neilan et al 2013;Xie et al 2013). It follows, therefore, that PAP treatment after cardiac surgery may reduce the risk of POAF.…”

Section: Discussionmentioning

confidence: 99%

“…In nonsurgical OSA patients, PAP therapy has been shown to reduce the recurrence rate of atrial fibrillation (Qureshi et al 2015). However, no studies have investigated the effect of postoperative PAP on POAF after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Effect of postoperative positive airway pressure on risk of postoperative atrial fibrillation after cardiac surgery in patients with obstructive sleep apnea: a retrospective cohort study

Ding

Wong

Whittemore

et al. 2017

Sleep Science Practice

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Background: Obstructive sleep apnea (OSA) is a known risk factor for postoperative atrial fibrillation (POAF) after cardiac surgery. However, whether better management of OSA reduces the risk of POAF remains unknown. The aim of this study was to determine if postoperative positive airway pressure (PAP) treatment for OSA reduces POAF risk after cardiac surgery. PAP included both continuous and bilevel positive airway pressure. Methods: This retrospective cohort study was conducted at Stanford University teaching hospital. We included a total of 152 OSA patients with preoperative electrocardiography showing sinus rhythm who underwent coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve repair/replacement, or combined valve and CABG surgery from October 2007 to September 2014. Postoperative PAP use status was determined by reviewing electronic health records. The primary outcome was time to incident POAF. We reviewed records from the time of surgery to hospital discharge. Multivariate Cox regression model was used to calculate the adjusted hazard ratio of postoperative PAP in association with risk of POAF. Results: Of the 152 OSA patients included for analysis, 86 (57%) developed POAF, and 76 (50%) received postoperative PAP treatment. POAF occurred in 37 (49%) of the patients receiving postoperative PAP, compared with 49 (65%) of those not receiving postoperative PAP (unadjusted p value = 0.33). Multivariable Cox regression analysis of time to incident POAF did not show an association between postoperative PAP treatment and risk of POAF (adjusted hazard ratio: 0.93 [95%CI: 0.58 -1.48]). There were no significant differences in other postoperative complications between the two groups. Conclusions: The study did not find an association between postoperative PAP treatment and risk of POAF after cardiac surgery in patients with OSA. Future prospective randomized trials are needed to investigate this issue further.

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

Cited by 151 publications

References 32 publications

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes

Sleep Apnea

Effect of postoperative positive airway pressure on risk of postoperative atrial fibrillation after cardiac surgery in patients with obstructive sleep apnea: a retrospective cohort study

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