The Impact of Continuous Positive Airway Pressure Therapy on the Recurrence of Atrial Fibrillation in Patients with Obstructive Sleep Apnea after pulmonary vein isolation

Background Despite the recognized risk of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) in patients with obstructive sleep apnea (OSA), the effect of continuous positive airway pressure (CPAP) remains inconsistent across studies, necessitating further examination. Methods Utilizing databases encompassing Web of Science, Pubmed and OVID, we implemented a meta-analysis dedicated to investigating the role of OSA in post-PVI AF recurrence and the preventative properties of CPAP. Results Our meta-analysis of OSA patients undergoing PVI suggests an AF recurrence risk with a RR (risk ratio) of 1.67 (95% CI: 1.52-1.83). For patients with no atrial size difference, the risk is RR=2.13 (95% CI: 1.63-2.79), and with size difference, it’s RR=1.78 (95% CI: 1.46-2.17). Diagnoses from the Berlin questionnaire and polysomnography yielded RRs of 1.71 (95% CI: 1.37-2.14) and 1.75 (95% CI: 1.40-2.18), respectively. Non-CPAP usage increases AF recurrence risk by 67% and especially in cases of significant atrial size difference (RR=1.63, 95%CI:1.32-2.03). Conversely, when atrial size difference is absent, the impact of CPAP appears to be insignificant (RR=1.22, 95%CI: 0.98-3.02). Co-existence of paroxysmal and non-paroxysmal AF indicates a significant CPAP effect (RR=1.78, 95% CI: 1.50-2.09), contrary to one study on paroxysmal AF patients (RR=1.3, 95%CI: 0.71-1.50). Conclusion Our meta-analysis found a significant risk of AF recurrence in patients with OSA following PVI. However, OSA had an insignificant impact on AF recurrence in paroxysmal AF patients. Non-CPAP usage generally increased recurrence risk. Yet, in subgroups without prominent atrial size difference and paroxysmal AF, CPAP’s influence was not significant. Keywords: CPAP; Atrial Fibrillation; Obstructive Sleep Apnea; Pulmonary vein isolation