Treatment of Obstructive Sleep Apnea Reduces the Risk of Atrial Fibrillation Recurrence After Catheter Ablation

Abstract

CPAP is an important therapy in OSA patients undergoing PVI that improves arrhythmia free survival. PVI offers limited value to OSA patients not treated with CPAP.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Obturacyjny bezdech senny nasila zmiany ciśnienia wewnątrz klatki piersiowej, które same oraz za pośrednictwem aktywacji nerwu błędnego mogą prowadzić do skrócenia potencjału czynnościowego w przedsionkach i wywoływać AF. Redukcja czynników ryzyka oraz wentylacja z ciągłym dodatnim ciśnieniem w drogach oddechowych mogą ograniczać nawroty AF [308][309][310][311][312]. Wydaje się rozsąd-nym rozważanie przesiewowego wykrywania obturacyjnego bezdechu sennego u pacjentów z AF i obciążonych czynnikami ryzyka.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…311 Treatment of OSA with CPAP, however, appears to favorably impact AF management, regardless of the rhythm control strategy adopted. 315,316 …”

“…283,289,290,291,316,317,318,319 Although OSA has been associated with poorer outcomes, CPAP appears to attenuate the deleterious impact of OSA. Pooled analysis suggests that although OSA increases the risk of AF recurrence following ablation (RR 1.31; 95% CI 1.16–1.48; P <.001), CPAP therapy improves ablation success to rates comparable with non-OSA populations (RR 1.25; 95% CI 0.77–2.03; P = .37).…”

“…Clinical history or diagnostic questionnaires (e.g., Berlin questionnaire) formed the basis of OSA diagnosis in some, whereas the diagnosis was rarely excluded by sleep study in non-OSA groups. 283,289,290,291,316 Similarly, treatment efficacy was assessed by self-reported CPAP use. 289,290,291,316 These study deficiencies lead to a poorly defined treatment effect of CPAP on AF recurrence after ablation.…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…200 Observational studies have demonstrated a significantly lower risk of recurrent AF in patients with treated compared with untreated OSA. 481 …”