Treating obstructive sleep apnea with continuous positive airway pressure reduces risk of recurrent atrial fibrillation after catheter ablation: a meta-analysis

Introduction: Recent studies have suggested that there is a strong relationship between obstructive sleep apnea (OSA) and atrial fibrillation (AF). However, they have not identified whether treating OSA with continuous positive airway pressure (CPAP) might reduce rates of recurrent AF. Objective: To investigate the recurrent risk of AF after catheter ablation among patients with OSA who did receive or did nor receive CPAP therapy. Methods: A systematic review of PubMed, Embase, Medline, Cochrane library, China National Knowledge Infrastructure (CNKI) and Wan-fang databases was conducted to obtain relevant cohort studies and randomized controlled trials (RCTs). Study characteristics of AF patients were extracted, and their recurrent outcomes were recorded. A meta-analysis was then conducted using Review Manager software, version 5.3. In total, seven eligible cohort studies and three randomized controlled trials involving 1217 participants with AF after catheter ablation were included. These participants were divided into a CPAP group (n = 619, 50.86%) and non-CPAP group (n = 598, 49.14%). Results: After a mean follow-up of 16.33 +/- 10.34 months, 408 patients (33.52%) experienced recurrent AF, and the recurrence rate differed between the CPAP and non-CPAP groups (24.88% vs 42.47%; RR 0.60; 95% CI 0.51-0.70; p = 0.000). Overall, patients treated with CPAP had a lower risk of recurrent AF after catheter ablation than those who did not, and about 17.59% of cases with recurrent AF could be attributed to not receiving CPAP. Meanwhile, the results indicated that CPAP therapy decreased the left atrial diameter (LAD) (WMD -6.28; 95% CI -7.00 to -5.56; p = 0.000) and increased left ventricular ejection fraction (LVEF) (WMD 7.37; 95% CI 6.98-7.76; p = 0.000). Conclusion: OSA had an increased risk of recurrent AF after successful catheter ablation, and CPAP treatment for AF patients with OSA might have significantly mitigated the recurrent risks. (C) 2018 Elsevier B.V. All rights reserved.