Continuous positive airway pressure reduces the incidence of atrial fibrillation in patients with obstructive sleep apnea: A Meta-Analysis and Systematic Review

INTRODUCTION: Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are disorders that have increased in the United States during recent years. Earlier investigations have shown that underlying undiagnosed and unmanaged OSA plays a significant role in high rates and also as a trigger for newly diagnosed AF. Since the introduction of continuous positive airway pressure (CPAP) as a main therapy for OSA, more studies have evaluated the effect of CPAP on the development or recurrence of AF in OSA patients. However, sample sizes in a limited number of studies have been too small to conclude whether CPAP therapy has a significant effect on the development of AF in patients with OSA. The authors report results of their systematic review and meta-analysis summarizing what is currently known about the efficacy of CPAP for mitigating AF in patients with OSA. METHOD: The authors systematically reviewed the published reports on CPAP use and the incidence of AF from PubMed, Google Scholar, EMBASE, Web of Science, meeting abstracts, and Cochrane databases published between January 2015 and November 2021. Study data were extracted by two reviewers and a random-effects meta-analysis was performed using RevMan version 5.4. RESULTS: A total of 17 studies that met inclusion criteria were identified Studies included a total of 6,523 patients, 3,248 (49.8%) who used CPAP and 3,275 (50.2%) who did not use CPAP. In a random effects model, patients treated with CPAP showed a decrease in the incidence of AF (OR, 0.51; 95% CI; 0.27; 0.97, p = 0.04). High heterogeneity among the included studies was also observed (I2 = 97%). CONCLUSION: Our results add to the increasing evidence that CPAP therapy may reduce the incidence of development of AF in patients with OSA. Prospective future studies and clinical trials are needed to refine our understanding of the relationship between OSA and AF and how CPAP may reduce cardiovascular disease development.