title: Obstructive sleep apnea as a predictor of atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.
abstract: BACKGROUND
  Post-coronary artery bypass grafting atrial fibrillation (PCAF) is associated with increased morbidity, mortality, and system costs. Few studies have explored obstructive sleep apnea (OSA) as a risk factor for PCAF. We aimed to systematically review and synthesize the evidence associating OSA with PCAF.
  
  
  METHODS
  We conducted a search of MEDLINE, EMBASE, Google Scholar, and Web of Science, as well as abstracts, conference proceedings, and reference lists until June 2014. Eligible studies were in English, were conducted in humans, and assessed OSA with polysomnography (PSG) or a validated questionnaire. Two reviewers independently selected studies, with disagreement resolved by consensus. Piloted forms were used to extract data and assess risk of bias.
  
  
  RESULTS
  Five prospective cohort studies were included (n = 642). There was agreement in study selection (κ statistic, 0.89; 95% confidence interval [CI], 0.75-1.00). OSA was associated with a higher risk of PCAF (odds ratio [OR], 1.86; 95% CI 1.24-2.80; P = 0.003; I(2) = 35%). We conducted 3 subgroup analyses. The associations increased for data that used PSG to assess OSA (OR, 2.34; 95% CI, 1.48-3.70), when severe OSA was included from 1 study (OR, 2.59; 95% CI, 1.63-4.11), and when adjusted analyses were pooled (OR, 2.38; 95% CI, 1.57-3.62; P < 0.001 in all), with no heterogeneity detected in any subgroup analysis (I(2) < 0.01% in all).
  
  
  CONCLUSIONS
  OSA was shown to be a strong predictor of PCAF.
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Amro
authors.initials: A
authors.lastname: Qaddoura
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Conrad
authors.initials: C
authors.lastname: Kabali
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Doran
authors.initials: D
authors.lastname: Drew
authors.affiliation: Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Erik M
authors.initials: EM
authors.lastname: van Oosten
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Michael
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors.forename: Damian P
authors.initials: DP
authors.lastname: Redfearn
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Simpson
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada. Electronic address: barancha@kgh.kari.net.
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D014943:Global Health; D006801:Humans; D015994:Incidence; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*