Use of CPAP May Reduce AF Recurrence in Patients With Sleep Apnea, With or Without Ablation

Deborah Brauser

April 23, 2015

NEW YORK, NY — Use of continuous positive airway pressure (CPAP) is associated with a significant decrease in atrial fibrillation in patients with both recurrent AF and obstructive sleep apnea (OSA), suggests a new analysis[1].

In fact, the meta-analysis of seven studies and 1087 total patients with OSA showed a 42% relative risk (RR) reduction in AF recurrence in those receiving CPAP. Interestingly, the association remained significant in both those who did and who did not undergo catheter ablation with pulmonary vein isolation (PVI).

In the March 2015 issue of JACC: Clinical Electrophysiology, the investigators, led by Dr Ashish Shukla (New York University School of Medicine, NY), note that the pooled analysis "presents robust evidence" that CPAP use can affect AF. "These study findings are . . . the most conclusive evidence available and give the clinician an additional means to reduce AF recurrence in patients with OSA," they write.

Guideline Revisions Needed?

The investigators note that although OSA as a risk factor for AF is recognized in current AF guidelines, there is no recommendation to screen for the condition.

They add that although links between CPAP use and reductions in AF have been shown previously, those results were often single-center studies with small patient populations. "Consequently, there remains a significant need to comprehensively evaluate the available data to develop a consensus," they write.

The investigators examined seven prospective cohort studies, published between 2003 and 2013, to compare CPAP users (n=557) vs nonusers (n=530). Of these studies, five had AF patients who underwent catheter ablation with PVI and two did not. Instead, those patients were given medication, including antiarrhythmic drugs.

Five of the studies were conducted in the US; the other two were in Spain and Japan.

When the researchers examined all participants, the CPAP users had significantly reduced AF recurrence rates vs the non-CPAP users (RR 0.58, 95% CI 0.51–0.67; P<0.001). The figures were almost identical in subgroup analysis for the CPAP users who underwent PVI vs the nonusers (RR 0.58, 95% CI 0.50–0.67; P<0.001). A significantly lower risk of AF recurrence was also found in the CPAP users who did not undergo PVI (RR 0.58, 95% CI 0.36–0.96; P=0.03).

Sensitivity analysis "revealed that no single study dominated an effect upon the pooled outcomes," report the investigators. After one study at a time was excluded, the AF RRs ranged from 0.55 to 0.59. Even when the largest study (n=640) was excluded, the RR was still 0.55.

None of the covariates examined showed any association with AF recurrence. This included patient age, sex, and BMI and having hypertension, diabetes, or CAD.

"Given the 42% relative risk reduction seen in the present study, which may now evolve to be a third major treatment option (in addition to medical therapy and ablation), revision of the current AF guidelines may be in order," write the investigators.

And although additional randomized controlled trials are needed to specifically assess efficacy of CPAP, "its use and adherence needs to be promoted aggressively in these patient groups," they conclude.

Shukla reports no relevant financial relationships. Disclosures for the coauthors are listed in the article.

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