Continuous positive airway pressure therapy prevents the recurrence of
atrial fibrillation in patients with severer atrial fibrillation and
hypertension: a systematic review and meta-analysis
Aim: A higher incidence of atrial fibrillation is linked to
obstructive sleep apnea. The effects of continuous positive airway
pressure on atrial fibrillation have been studied in observational
studies and randomized controlled trials. We conducted this
meta-analysis to assess the effect of continuous positive airway
pressure therapy on the recurrence of atrial fibrillation after
conversion to sinus rhythm in obstructive sleep apnea patients.
Methods: A comprehensive search was conducted in MEDLINE,
Embase, Cochrane, and Web of Science databases from inception till
October 2022. We included cohort studies and randomized controlled
trials containing the recurrent situation of atrial fibrillation after
catheter ablation or direct current cardioversion with and without
continuous positive airway pressure therapy. The random-effects model
was used to evaluate the odds ratios (OR) and confidence intervals (CI).
I2 was used to assess the heterogeneity.
Results: 8 studies with a total of 1372 obstructive sleep apnea
patients met the inclusion criteria. Continuous positive airway pressure
therapy decreased atrial fibrillation recurrence by 57% (OR=0.43, 95%
CI 0.29-0.64, I2=38.0%). Subgroup analysis
showed that the protective effect was more significant in groups with a
higher burden of atrial fibrillation (OR 0.294 vs. 0.622, 95% CI
0.164-0.524 vs. 0.376-1.027, p=0.055) and with more hypertension
patients (OR 0.272 vs. 0.550, 95% CI 0.165-0.449 vs. 0.329-0.922,
p=0.054). Age, body mass index, severity of OSA, and therapy compliance
had no significant effect on the recurrence of atrial fibrillation.
Conclusion: Continuous positive airway pressure therapy
decreased the atrial fibrillation recurrence rate. The severity of
atrial fibrillation and hypertension both had an impact on it. Studies
focused on the effects of the severity of OSA and treatment compliance,
and more randomized controlled trials are needed in the future.