Meta-Analysis of Continuous Positive Airway Pressure as a Therapy of Atrial Fibrillation in Obstructive Sleep Apnea.
Atrial fibrillation (AF) is a significant health care problem for patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) as a therapy for OSA is underused, and it is unknown if CPAP might reduce rates of AF. We systematically reviewed the published reports on CPAP use and risk of AF. MEDLINE, EMBASE, CINAHL, Web of Science, meeting abstracts, and Cochrane databases were searched from inception to June 2015. Studies needed to report the rates of AF in participants who were and were not on CPAP. Data were extracted by 2 authors. A total of 8 studies on OSA were identified (1 randomized controlled trial) with 698 CPAP users and 549 non-CPAP users. In a random effects model, patients treated with CPAP had a 42% decreased risk of AF (pooled risk ratio, 0.58; 95% confidence interval, 0.47 to 0.70; p <0.001). There was low heterogeneity in the results (I(2) = 30%). In metaregression analysis, benefits of CPAP were stronger for younger, obese, and male patients (p <0.05). An inverse relationship between CPAP therapy and AF recurrence was observed. Results suggest that more patients with AF also should be tested for OSA.
Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: WQureshi@wakehealth.edu.
Waqas T
WT
Qureshi
University of Health Sciences, Lahore, Pakistan.
Usama Bin
UB
Nasir
Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri.
Shehabaldin
S
Alqalyoobi
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Wesley T
WT
O'Neal
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
Sagar
S
Mawri
Section on Hospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Salah
S
Sabbagh
Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina.
Elsayed Z
EZ
Soliman
King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
Mouaz H
MH
Al-Mallah
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D006801:Humans; D012008:Recurrence; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy