Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting.
Patients with obstructive sleep apnea (OSA) have intermittent hypoxia leading to atrial remodeling and this has been associated with the development of atrial fibrillation (AF). Postoperative AF is a common complication of coronary artery bypass grafting (CABG). The aim of this prospective study was to determine whether the presence of OSA predicts the occurrence of post-CABG AF (PCAF). This was a prospective single-center study. Patients undergoing elective CABG were evaluated and categorized as confirmed, high-risk, or low-risk OSA according to a modified Berlin questionnaire. PCAF was evaluated by 24-hour cardiac monitoring strip or 12-lead electrocardiography during the postoperative period, and validated by an electrophysiologist. We included 277 patients. OSA prevalence was 47.7%, with body mass index (31.0 vs 26.9 kg/m(2), p ≤0.001), advanced age (63.7 vs 66.4 years, p = 0.031), hypertension (78.0% vs 64.8%, p = 0.015), and diabetes (45.5% vs 28.3%, p = 0.003) more prevalent in the OSA group. PCAF was found to occur in 37.2% of all patients and OSA was found to be a strong predictor of PCAF (45.5% vs 29.7%, p = 0.007). PCAF was also associated with continuous positive airway pressure use (12.6% vs 5.2%, p = 0.027). Increased length of stay was associated with PCAF (6.5 vs 5.3 days, p = 0.006), as was longer time from surgery to occurrence of PCAF (p = 0.001). In conclusion, OSA was found to be a strong predictor of PCAF, which in turn was found to be associated with increased length of stay.
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Erik M
EM
van Oosten
Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Andrew
A
Hamilton
Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Dimitri
D
Petsikas
Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Darrin
D
Payne
Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Damian P
DP
Redfearn
Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
Shetuan
S
Zhang
Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Wilma M
WM
Hopman
Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada. Electronic address: barancha@kgh.kari.net.
Adrian
A
Baranchuk
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications; D057234:Preoperative Period; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends