Effects of continuous positive airway pressure therapy on the recurrence and progression of atrial fibrillation in patients with concomitant obstructive sleep Apnea: a systematic review

Résumé fourni par la source

Obstructive Sleep Apnea (OSA) has been frequently linked with the development of atrial fibrillation (AF) due to the underlying mechanism of hypoxia-induced surge in sympathetic activity leading to electrical changes in the heart. Continuous positive airway pressure (CPAP), the mainstay treatment modality for OSA, is known to lower the incidence of abnormal electrophysiological changes. Therefore, there has been a growing interest in investigating the relationship of CPAP therapy on the progression and recurrence of AF. PubMed, Scopus and the Cochrane Library were comprehensively and exhaustively searched for randomized controlled trials (RCTs) and observational studies evaluating the effects of CPAP therapy on alleviating the progression and recurrence of AF in OSA patients. Inclusion criteria of the studies were: (1) Patients aged ≥ 18; (2) OSA diagnosis based on polysomnography or Home Sleep Apnea Testing (HSAT), and diagnostic criteria was based on apnea–hypopnea index (AHI) which is defined as number of apnea and hypopnea episodes per hour of sleep, thus either AHI ≥ 15 events per hour or AHI ≥ 5 events per hour with symptoms or comorbidities; and (3) at least intermediate adherence to CPAP therapy according to Centers for Medicare and Medicaid Services (CMS) which states that using the CPAP machine for at least 4 h per night on at least 70% of nights during a consecutive 30-day period in at least one, but no more than three, of the four 90-day periods within the first year. Studies assessing central sleep apnea or participants who had undergone additional procedures for AF such as pulmonary vein isolation (PVI) or radiofrequency ablation were excluded. In the total of 9 studies that we included in our systematic review, 3 studies recorded significant reduction in the incidence and progression of arrhythmias, particularly AF after adequate use of CPAP therapy which is defined as using CPAP device for minimum 4 h each nigh on at least 70% of nights within a 30-day period. By adhering to CPAP therapy, there was a marked decrease in the level of several inflammatory markers that were positively correlated with the incidence of arrhythmias. CPAP therapy also contributed to a reduction in Apnea–Hypopnea index (AHI) in several population groups. Findings from our systematic review suggest that it is important to conduct more RCTs involving large population cohorts to evaluate the effects of CPAP therapy on the progression and recurrence of AF in patients with concomitant OS as CPAP is a notable factor contributing to the pathogenesis AF.

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