Efficacy of continuous positive airway pressure on atrial fibrillation recurrence after catheter ablation in patients with obstructive sleep apnea: a systematic review and meta-analysis

Abstract

Background: Obstructive sleep apnea (OSA) is associated with an increased risk of atrial fibrillation (AF). However, the impact of continuous positive airway pressure (CPAP) on the recurrence of AF after catheter ablation (CA) in patients with OSA remains unclear.

Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing CPAP vs. no CPAP use for OSA treatment and recurrence of AF following CA. Heterogeneity was assessed with I² statistics.

Results: We included 1 RCT and 10 observational studies with 1536 patients with OSA who underwent CA for AF, of whom 53% used CPAP. Mean follow-up ranged from 3 to 42 months. In the pooled analysis, AF recurrence (OR 0.37; 95% CI 0.23-0.58; p < 0.01) was significantly lower in patients treated with CPAP compared with no CPAP. In the subgroup analysis, the AF recurrence in the CPAP group was also significantly lower after restricting to studies with longer follow-up periods ≥ 18 months (OR 0.28; 95% CI 0.18-0.46; p < 0.01) and in studies with a greater proportion of persistent AF (≥ 50%) (OR 0.31; 95% CI 0.16-0.61; p < 0.01).

Conclusion: In patients with OSA and AF who underwent CA, CPAP use was associated with reduced AF recurrence compared to no CPAP use. Most of the data available is derived from observational studies, and the only RCT showed no difference between groups. Thus, results should be interpreted with caution.

Keywords: Atrial fibrillation; CPAP; Continuous positive airway pressure; Obstructive sleep apnea; Recurrence.