Adherence to CPAP for patients with atrial fibrillation undergoing catheter ablation: A "real-world" analysis

The relationship between obstructive sleep apnea (OSA) and atrial fibrillation (AF) is well established, as the existing literature has concluded that sleep apnea creates a unique, complex, and dynamic substrate for AF with various pathophysiological mechanisms. Little is known about the role of continuous positive airway pressure (CPAP) therapy in reversing the risk of AF recurrence in patients with OSA. Awareness of the therapeutic effects of CPAP in preventing AF recurrence postablation will help create a multidisciplinary team of doctors to treat this complex population of patients.

The goals of this study were to examine the effect of CPAP adherence on AF-free survival post-catheter ablation and to identify the indicated average CPAP use to maximize AF-free survival postablation.

We selected 190 consecutive patients who underwent catheter ablation for AF at Lenox Hill Hospital in New York and who had a concurrent diagnosis of OSA. In this retrospective case-control study, 97 (51%) patients with OSA adherent to CPAP use were carefully matched with 93 (49%) patients who were not adherent to CPAP guidelines for patients with OSA.

The mean age of the population was 66.3 ± 9.4 years, and 78% were male. Patients in the adherent group had a recurrence rate of 24% until their last follow-up visit compared with 42% in the nonadherent group (P=.02). In a stepwise multivariate regression model, adherence to CPAP was independently associated with lower chances of composite AF recurrence with an odds ratio of 0.24 (CI 95% = 0.08-0.68; P = .007). Using the receiver operating characteristic curve, we identified the optimal average nightly CPAP duration required to observe a clinical benefit and reperformed the above analysis. With a new cutoff set at 287 minutes of CPAP per night, the adjusted odds ratio for AF recurrence was 0.17 (CI 95% = 0.12-0.71; P=.004). In a secondary analysis, patients who were not adherent to optimal CPAP use did not show any benefit compared with patients who did not use CPAP at all (56% vs 59%; P = .75).

Consistent nightly CPAP use offers a 3-year AF-free survival postablation in 1 of 5 patients with OSA who undergo ablation for AF. Inconsistent CPAP use, defined as <287 minutes per night, offers no benefit compared with no CPAP.