title: Obstructive Sleep Apnea Is an Independent Predictor of Postoperative Atrial Fibrillation in Cardiac Surgery.
abstract: OBJECTIVE
  To test the hypothesis that obstructive sleep apnea (OSA) is a risk factor for development of postoperative atrial fibrillation (POAF) after cardiac surgery.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Single-center university hospital.
  
  
  METHODS
  Five hundred forty-five patients in sinus rhythm preoperatively undergoing coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement/repair, or combined valve/CABG surgery from January 2008 to April 2011.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  RESULTS
  Postoperative atrial fibrillation was defined as atrial fibrillation requiring therapeutic intervention. Of 545 cardiac surgical patients, 226 (41%) patients developed POAF. The risk was higher in 72 OSA patients than 473 patients without OSA (67% v 38%, adjusted hazard ratio 1.83 [95% CI: 1.30-2.58], p<0.001). Of the 32 OSA patients who used home positive airway pressure (PAP) therapy, 18 (56%) developed POAF compared with 29 of 38 (76%) patients who did not use PAP at home (unadjusted hazard ratio 0.63 [95% CI: 0.35-1.15], p = 0.13).
  
  
  CONCLUSIONS
  OSA is significantly associated with POAF in cardiac surgery patients. Further investigation is needed to determine whether or not use of positive airway pressure in OSA patients reduces the risk of POAF.
authors.affiliation: Departments of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA. Electronic address: wongjk2003@gmail.com.
authors.forename: Jim K
authors.initials: JK
authors.lastname: Wong
authors.affiliation: Anesthesia and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Maxwell
authors.affiliation: Psychiatry & Behavioral Science-Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Health Research and Policy, Stanford University, Stanford, CA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Sainani
authors.affiliation: Department of Anesthesia; Veterans Affairs Medical Center, West Los Angeles, Los Angeles, CA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Lobato
authors.affiliation: Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
authors.affiliation: Departments of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Pearl
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*
keywords: cardiac surgery; obstructive sleep apnea; postoperative atrial fibrillation