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Comparative Study
. 2003 May 27;107(20):2589-94.
doi: 10.1161/01.CIR.0000068337.25994.21. Epub 2003 May 12.

Obstructive sleep apnea and the recurrence of atrial fibrillation

Ravi Kanagala  1 , Narayana S Murali, Paul A Friedman, Naser M Ammash, Bernard J Gersh, Karla V Ballman, Abu S M Shamsuzzaman, Virend K Somers
Affiliations
Comparative Study

Obstructive sleep apnea and the recurrence of atrial fibrillation

Ravi Kanagala et al. Circulation. .

Abstract

Background: We tested the hypothesis that patients with untreated obstructive sleep apnea (OSA) would be at increased risk for recurrence of atrial fibrillation (AF) after cardioversion.

Methods and results: We prospectively obtained data on history, echocardiogram, ECG, body mass index, hypertension, diabetes, NYHA functional class, ejection fraction, left atrial appendage velocity, and medications in patients with AF/atrial flutter referred for DC cardioversion. Forty-three individuals were identified as having OSA on the basis of a previous sleep study. Data regarding the use of continuous positive airway pressure (CPAP) and recurrence of AF were obtained for 39 of these patients. Follow-up data were also obtained in 79 randomly selected postcardioversion patients (controls) who did not have any previous sleep study. Twenty-seven of the 39 OSA patients either were not receiving any CPAP therapy (n=25) or were using CPAP inappropriately (n=2). Recurrence of AF at 12 months in these 27 patients was 82%, higher than the 42% recurrence in the treated OSA group (n=12, P=0.013) and the 53% recurrence (n=79, P=0.009) in the 79 control patients. Of the 25 OSA patients who had not been treated at all, the nocturnal fall in oxygen saturation was greater (P=0.034) in those who had recurrence of AF (n=20) than in those without recurrence (n=5).

Conclusions: Patients with untreated OSA have a higher recurrence of AF after cardioversion than patients without a polysomnographic diagnosis of sleep apnea. Appropriate treatment with CPAP in OSA patients is associated with lower recurrence of AF.

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