title: Preoperative Treatment of Obstructive Sleep Apnea With Positive Airway Pressure is Associated With Decreased Incidence of Atrial Fibrillation After Cardiac Surgery.
abstract: OBJECTIVE
  Based on clinical studies in the nonsurgical population that positive airway pressure (PAP) therapy for patients with obstructive sleep apnea (OSA) provides benefits for those with atrial fibrillation, the authors tested the hypothesis that PAP in patients with OSA reduces the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Single-center university hospital.
  
  
  METHODS
  The study comprised 192 patients in sinus rhythm preoperatively who were undergoing nontransplantation or ventricular assist device implantation cardiac surgery requiring cardiopulmonary bypass but not requiring systemic circulatory arrest, with documented PAP adherence from January 2008 to October 2015.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  RESULTS
  POAF was defined as atrial fibrillation requiring therapeutic intervention. Of the 192 patients with OSA, 104 (54%) were documented to be PAP-adherent and 88 (46%) were reported to be PAP-nonadherent. Among PAP users, 49 (47%) developed POAF; among PAP nonusers, 59 (66%) developed POAF. The adjusted hazard ratio was 0.59 (95% confidence interval 0.40-0.86, p<0.01). No differences were observed in intensive care unit length of stay (4.0±3.4 days for PAP-adherent group v 5.0±6.2 days for PAP-nonadherent group; p = 0.22) or hospital length of stay (10.7±6.6 days for PAP-adherent group v 10.9±7.3 days for PAP nonadherent group; p = 0.56). A lower median postoperative creatinine rise was observed in PAP-adherent patients (18.2% [8.3%-37.5%) v 31.3% [13.3%-50%]; p< 0.01).
  
  
  CONCLUSIONS
  Preoperative PAP use in patients with OSA was associated with a decreased rate of POAF after cardiac surgery.
authors.affiliation: Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA. Electronic address: wongjk2003@gmail.com.
authors.forename: Jim K
authors.initials: JK
authors.lastname: Wong
authors.affiliation: Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
authors.affiliation: Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Doufas
authors.affiliation: Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Olejniczak
authors.affiliation: Department of 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
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
keywords: cardiac surgery; obstructive sleep apnea; positive airway pressure; postoperative atrial fibrillation