Obstructive Sleep Apnea and the Recurrence of Atrial Fibrillation
Abstract
Background— We tested the hypothesis that patients with untreated obstructive sleep apnea (OSA) would be at increased risk for recurrence of atrial fibrillation (AF) after cardioversion. Methods and Results— We prospectively obtained data on history, echocardiogram, ECG, body mass index, hypertension, diabetes, NYHA functional class, ejection fraction, left atrial appendage velocity, and medications in patients with AF/atrial flutter referred for DC cardioversion. Forty-three individuals were identified as having OSA on the basis of a previous sleep study. Data regarding the use of continuous positive airway pressure (CPAP) and recurrence of AF were obtained for 39 of these patients. Follow-up data were also obtained in 79 randomly selected postcardioversion patients (controls) who did not have any previous sleep study. Twenty-seven of the 39 OSA patients either were not receiving any CPAP therapy (n=25) or were using CPAP inappropriately (n=2). Recurrence of AF at 12 months in these 27 patients was 82%, higher than the 42% recurrence in the treated OSA group (n=12, P =0.013) and the 53% recurrence (n=79, P =0.009) in the 79 control patients. Of the 25 OSA patients who had not been treated at all, the nocturnal fall in oxygen saturation was greater ( P =0.034) in those who had recurrence of AF (n=20) than in those without recurrence (n=5). Conclusions— Patients with untreated OSA have a higher recurrence of AF after cardioversion than patients without a polysomnographic diagnosis of sleep apnea. Appropriate treatment with CPAP in OSA patients is associated with lower recurrence of AF.
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Observational studies generally found that OSA patients not treated with CPAP are significantly more likely to have recurrent atrial fibrillation after electrical cardioversion or ablation than CPAP-treated patients, with two- to six-fold higher adjusted risk of recurrence.
“These studies have generally found that patients with OSA who are not treated with CPAP are significantly more likely to have recurrent AF than CPAP-treated patients, with two- to six-fold higher adjusted risk of recurrence.708,729,730,1215,1216”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1216]
The Results report significantly more AF recurrence at 12 months after cardioversion in OSA patients without appropriate CPAP use than in those treated appropriately (82% versus 42%; P=0.013). The Methods describe comparisons of recurrence rates, but this paper does not report a two- to six-fold adjusted risk or study recurrence after ablation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPatients with untreated OSA have twice the risk of recurrence of atrial fibrillation compared to those treated with CPAP.
“patients with untreated OSA had twice the risk of recurrence of atrial fibrillation compared to the group who were treated with Continuous Positive Airway Pressure (CPAP) therapy(88).”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [88]
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- Authors
- Kanagala, R., Murali, N. S., Friedman, P. A., Ammash, N. M., Gersh, B. J., Ballman, K. V., M. Shamsuzzaman, A. S., & Somers, V. K.
- Affiliations
- Mayo Clinic (US)
- From the Mayo Clinic, Rochester, Minn.
- Venue
- Circulation
- Published
- 2003-05-27
- Volume
- 107
- Issue
- 20
- Pages
- 2589-2594
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2166034725
- Semantic Scholar
- 4d1d8e2eb0eec2b17a912f1a22e27d1c59944409
- Cited by
- 983
- References
- 27
- Citations by year
- 2026: 22 · 2025: 30 · 2024: 21 · 2023: 29 · 2022: 36 · 2021: 42 · 2020: 46 · 2019: 38 · 2018: 55 · 2017: 63 · 2016: 44 · 2015: 66 · 2014: 55 · 2013: 66 · 2012: 54
- FWCI
- 15.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Dana Foundation
- National Institutes of Health (65176, RR-00585)
- National Heart, Lung, and Blood Institute (HL65176, R01HL065176, HL70602, HL61560, R01HL061560)
- National Center for Research Resources (M01-RR00 585, M01RR000585)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- obstructive sleep apnea, atrial fibrillation recurrence, atrial flutter, electrical cardioversion, continuous positive airway pressure, CPAP therapy, nocturnal hypoxemia, polysomnography, left atrial appendage
- MeSH terms
- Aged, Atrial Fibrillation, Atrial Flutter, Diabetes Mellitus, Electric Countershock, Electrocardiography, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Minnesota, Oximetry, Positive-Pressure Respiration, Prospective Studies, Surveys and Questionnaires, Recurrence, Sleep, Comorbidity, Body Mass Index, Risk Assessment, Sleep Apnea, Obstructive
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