Effect of continuous positive airway pressure therapy in patients with paroxysmal atrial fibrillation and obstructive sleep apnea: a randomized controlled trial. (25th November 2020)

• Record Type: Journal Article
• Authors: Traaen, G.M; Aakeroy, L; Hunt, T.E; Overland, B; Bendz, C; Sande, L.O; Aakhus, S; Zare, H; Fagerland, M; Steinshamn, S; Bredesen, N; Anfinsen, O.G; Akre, H; Loennechen, J.P; Gullestad, L
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Atrial Fibrillation - Prevention; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.0670
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: There is strong evidence for an association between atrial fibrillation (AF) and sleep apnea (SA). Purpose: We aimed to examine the effect of treatment with continuous positive airway pressure (CPAP) on the burden of AF. Methods: After a run-in period for CPAP-tolerance, we randomly assigned 108 eligible patients between 18–75 years, who had paroxysmal AF and moderate-to-severe obstructive SA (apnea-hypopnea index (AHI)≥15), to receive either CPAP treatment (n=54) plus usual care or usual care alone (n=54) for five months. An implanted loop recorder measured time in AF continuously. The primary endpoint was the difference in change of AF burden (% of time in AF) between CPAP treatment and usual care from baseline (one month prior to randomization) to the last three months of the intervention period. Secondary endpoints were changes in quality of life assessed by the Short Form-36 (SF-36), Epworth Sleepiness Scale (ESS), and the Functional Outcomes of Sleep Questionnaire (FOSQ). Results: Mean (SD) age was 62.4 (7.7) years, BMI 29.4 (4.2) kg/m 2, ESS 7.9 (3.2), and 76.1% were men. In the intervention group, the mean duration of adherence to CPAP therapy was 4.3 hours/night. During treatment mean AHI decreased from 27.6 events/hour at baseline to 2.3 events/hour during follow-up. Mean time in AF decreased from 5.0%-4.3% in the control group and from 5.6%-4.1% in the CPAP group, but the difference in change was not significant (p=0.52). Sub-analysis of those using CPAP><4 hours/night also showed no difference, neither did the quality of life questionnaires. Conclusion: This is the first randomized controlled trial to assess the effect of treatment of SA on the burden of AF, and did not detect a difference between those treated with CPAP compared to usual care alone. Funding Acknowledgement: Type of funding source: Public hospital(s). Main funding source(s): Oslo University Hospital is the main funding Source. ResMed Science Center provided an unrestricted grant.