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CPAP is associated with decreased risk of AF recurrence in patients with OSA, especially those younger and slimmer: a meta-analysis

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Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with the management of atrial fibrillation (AF). This manuscript aims to discuss the effects of continuous positive airway pressure (CPAP) in patients with rhythm control strategies and patients with different ages, weights and length of follow-up.

Methods

We searched Embase, PubMed, Cochrane, Web of Science and Ovid for relevant studies (from inception to 7 July 2019; English). The primary outcome was documented AF recurrence in CPAP users and nonusers. We assessed pooled data by use of a random-effects model.

Results

Nine prospective cohort studies with a total of 2134 participants met the inclusion criteria. Results showed that complementary CPAP therapy reduced AF recurrence (RR = 0.63; 95% CI, 0.56–0.72). In subgroup analyses, the benefits of CPAP were stronger in patients younger than 60 years old (< 60 years old: RR, 0.59; 95% CI, 0.50–0.68 vs. ≥ 60 years old: RR, 0.73; 95% CI, 0.59–0.91), with a body mass index (BMI) of less than 30 (< 30: RR, 0.53; 95% CI, 0.37–0.77 vs. ≥ 30: RR, 0.65; 95% CI, 0.55–0.77) or with less follow-up time (≤ 1 year: RR, 0.57; 95% CI, 0.42–0.79 vs. > 1 year: RR, 0.64; 95% CI, 0.53–0.78).

Conclusions

Complementary CPAP therapy reduces the risk of AF recurrence in OSA patients with rhythm control strategies. In addition to weight control and early AF intervention, CPAP compliance should be recommended along with periodic adjustments as necessary.

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Funding

This study was financially supported by the International Science and Technology Cooperation Program of China (2015DFA30160) and Beijing Municipal Science and Technology Commission (Z141100006014057).

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Authors and Affiliations

  1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 100029, China

    Yunxiao Yang, Yu Ning, Wanwan Wen, Yifan Jia, Mengling Huang & Ming Zhang

  2. Department of Endocrinology, People’s Hospital of Gaotang Country, Liaocheng, Shandong, China

    Xiaoyuan Chen

  3. Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA

    Jaskanwal Deep Sara

  4. Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Yanwen Qin, Fang Fang, Huina Zhang, Yunhui Du, Linyi Li, Xiaolu Jiao, Yunyun Yang & Xingyu Han

  5. Department of Otolaryngology Head & Neck Surgery, Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Road, Chaoyang District, Beijing, 100029, China

    Xingyu Han & Yongxiang Wei

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  1. Yunxiao Yang
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  2. Yu Ning
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  3. Wanwan Wen
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Appendices

Appendix 1

Table 3 Newcastle-Ottawa scale
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Yang, Y., Ning, Y., Wen, W. et al. CPAP is associated with decreased risk of AF recurrence in patients with OSA, especially those younger and slimmer: a meta-analysis. J Interv Card Electrophysiol 58, 369–379 (2020). https://doi.org/10.1007/s10840-020-00738-6

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