TY - JOUR
T1 - The effect of positive airway pressure treatment of obstructive and central sleep apnea on the recurrence of atrial fibrillation/flutter postintervention
AU - Srivali, Narat
AU - Chahal, Anwar C.
AU - Mansukhani, Meghna P.
AU - Mandrekar, Jay
AU - Somers, Virend K.
AU - Caples, Sean M.
N1 - Funding Information:
All authors have seen and approved the manuscript. Work for this study was performed at Mayo Clinic, Rochester, Minnesota, USA. VKS is supported by research grants from the National Institutes of Health (HL 65176, HL 134808, HL 134885). MPM is the principal investigator on a research grant funded by ResMed Foundation that is unrelated to the current study and the recipient of the Paul and Ruby Tsai and Family Fund Career Development Award at Mayo Clinic, Rochester, Minnesota. VKS is a Consultant for Respicardia, ResMed, U-Health, GlaxoSmithKline, Roche, and Bayer. He is an investigator on the SERVE-HF Steering Committee and is working with Mayo Health Solutions and their industry partners on intellectual property related to sleep and cardiovascular disease. The Philips Respironics Foundation has provided a gift to the Mayo Foundation.
Publisher Copyright:
© 2019 American Academy of Sleep Medicine. All rights reserved.
PY - 2019/10/15
Y1 - 2019/10/15
N2 - Study Objectives: A strong association between sleep-disordered breathing (SDB) and atrial fibrillation and/or atrial flutter (AF) has consistently been observed in epidemiologic and interventional studies. The effect of positive airway pressure (PAP) on AF recurrence is inconclusive. This study sought to evaluate the effectiveness of PAP therapy for SDB on AF recurrence. Methods: This was a single-center, retrospective study conducted at a tertiary referral center. All adult patients who had SDB on polysomnography and underwent AF intervention (ablation or cardioversion) following polysomnography from January 1992-December 2014 were analyzed. Primary outcome was time to first-documented recurrence of AF after AF intervention by Kaplan–Meier estimates. Results: Among 30,188 patients with obstructive and central SDB, 429 had this diagnosis before AF intervention; 269 were “PAP-adherent users,” the remaining 160 were “PAP-nonusers.” Patients in both groups had similar age, sex, body mass index (BMI), ejection fraction, left atrial volume index (LAVI), antiarrhythmic medications, diabetes mellitus, systemic hypertension, and heart failure diagnoses. Time to recurrence of AF postintervention was no different in PAP-adherent users and nonusers (4.8 and 4.1 months respectively, P =.7). Cardioversion (compared to catheter ablation) was the strongest independent predictor of recurrent AF (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.39–2.94, P < .001). BMI and LAVI were also significant predictors of recurrence in adjusted analyses (HR 1.01, 95% CI 1.003–1.023, P = .10 and HR 1.01, 95% CI 1.001–1.019, P = .024 respectively). Conclusions: Our study found no effect of PAP treatment of SDB on time to recurrence of AF post-AF intervention. Increased risk of recurrent AF was associated with high BMI and LAVI. These findings may affect the clinical management of AF.
AB - Study Objectives: A strong association between sleep-disordered breathing (SDB) and atrial fibrillation and/or atrial flutter (AF) has consistently been observed in epidemiologic and interventional studies. The effect of positive airway pressure (PAP) on AF recurrence is inconclusive. This study sought to evaluate the effectiveness of PAP therapy for SDB on AF recurrence. Methods: This was a single-center, retrospective study conducted at a tertiary referral center. All adult patients who had SDB on polysomnography and underwent AF intervention (ablation or cardioversion) following polysomnography from January 1992-December 2014 were analyzed. Primary outcome was time to first-documented recurrence of AF after AF intervention by Kaplan–Meier estimates. Results: Among 30,188 patients with obstructive and central SDB, 429 had this diagnosis before AF intervention; 269 were “PAP-adherent users,” the remaining 160 were “PAP-nonusers.” Patients in both groups had similar age, sex, body mass index (BMI), ejection fraction, left atrial volume index (LAVI), antiarrhythmic medications, diabetes mellitus, systemic hypertension, and heart failure diagnoses. Time to recurrence of AF postintervention was no different in PAP-adherent users and nonusers (4.8 and 4.1 months respectively, P =.7). Cardioversion (compared to catheter ablation) was the strongest independent predictor of recurrent AF (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.39–2.94, P < .001). BMI and LAVI were also significant predictors of recurrence in adjusted analyses (HR 1.01, 95% CI 1.003–1.023, P = .10 and HR 1.01, 95% CI 1.001–1.019, P = .024 respectively). Conclusions: Our study found no effect of PAP treatment of SDB on time to recurrence of AF post-AF intervention. Increased risk of recurrent AF was associated with high BMI and LAVI. These findings may affect the clinical management of AF.
KW - Atrial fibrillation
KW - Positive airway pressure
KW - Recurrence
KW - Sleep apnea
KW - Treatment
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U2 - 10.5664/jcsm.7976
DO - 10.5664/jcsm.7976
M3 - Article
C2 - 31596211
AN - SCOPUS:85073077982
SN - 1550-9389
VL - 15
SP - 1459
EP - 1468
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 10
ER -