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Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation



Obstructive sleep apnea (OSA) has been recognized as an independent risk factor for the development and progression of atrial fibrillation (AF). We aimed to investigate the changes in heart rate and atrial and ventricular ectopy after continuous positive airway pressure (CPAP) treatment in patients with OSA and AF.


Consecutive patients with AF underwent ambulatory sleep monitoring, and OSA was defined as an Apnea-Hypopnea-Index (AHI) ≥ 5/h. Treated patients completed in-laboratory CPAP titration study. A 24-h ECG Holter was performed at baseline and at 3 and 6 months after CPAP treatment.


One hundred patients (70% males) with AF were included in the final analysis. OSA was diagnosed in 85% of patients. There were no significant changes in mean 24-h heart rate in patients with paroxysmal or permanent AF at 3 and 6 months of treatment compared to baseline. In patients with paroxysmal AF (n = 29), atrial and ventricular ectopy counts/24 h significantly decreased at 3 months compared to baseline (median (IQR) 351 (2049) to 57 (182), P = 0.002; 68 (105) to 16 (133), P = 0.01 respectively). At 6 months follow-up, the atrial ectopy count/24 h significantly decreased in patients with paroxysmal AF compared to baseline (median (IQR) 351 (2049) to 31 (113), P = 0.016, n = 14). In patients with permanent AF (n = 15), there was a significant reduction in ventricular ectopy count/24 h at 3 months compared to baseline (median (IQR) 100 (1116) to 33 (418), P = 0.02).


There is a significant decrease in atrial and ventricular ectopy count/24 h in patients with AF and OSA at 3 and 6 months of CPAP treatment compared to baseline.

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Atrial fibrillation




Continuous positive airway pressure




Obstructive sleep apnea




Total sleep time


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We appreciate the collaboration and administrative support of the staff at the Sleep and Alertness Clinic, the Cardiomatters Diagnostics, and the Atrial Fibrillation Clinic at St. Michael’s Hospital in Toronto, ON, Canada. We acknowledge the support of the Neurozone MSH Inc. Canada and the CPAP Direct Ltd.


The Neurozone MSH Inc. Canada provided the equipment of home sleep testing for participants in the study. CPAP devices and supplies were provided by the CPAP Direct Ltd.

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Correspondence to Asmaa M. Abumuamar.

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Ethical approval was obtained from University Health Network and St. Michael’s Hospital Research Ethics Boards.

Conflict of interest

CS has shares in the Neurozone MSH Inc. Canada which provided the equipment for the ambulatory sleep testing and the analysis of the sleep reports testing system. AA, DN, and PD have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Abumuamar, A.M., Newman, D., Dorian, P. et al. Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation. J Interv Card Electrophysiol 54, 289–297 (2019).

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  • Obstructive sleep apnea
  • Atrial fibrillation
  • Continuous positive airway pressure
  • Atrial ectopy
  • Ventricular ectopy
  • CPAP compliance
  • Arrhythmia
  • Ambulatory sleep monitoring