CPAP is associated with decreased risk of AF recurrence in patients with OSA, especially those younger and slimmer: a meta-analysis

Purpose Obstructive sleep apnea (OSA) is associated with the management of atrial fibrillation (AF). This manuscript aims to discuss the effects of continuous positive airway pressure (CPAP) in patients with rhythm control strategies and patients with different ages, weights and length of follow-up. Methods We searched Embase, PubMed, Cochrane, Web of Science and Ovid for relevant studies (from inception to 7 July 2019; English). The primary outcome was documented AF recurrence in CPAP users and nonusers. We assessed pooled data by use of a random-effects model. Results Nine prospective cohort studies with a total of 2134 participants met the inclusion criteria. Results showed that complementary CPAP therapy reduced AF recurrence (RR = 0.63; 95% CI, 0.56–0.72). In subgroup analyses, the benefits of CPAP were stronger in patients younger than 60 years old (< 60 years old: RR, 0.59; 95% CI, 0.50–0.68 vs. ≥ 60 years old: RR, 0.73; 95% CI, 0.59–0.91), with a body mass index (BMI) of less than 30 (< 30: RR, 0.53; 95% CI, 0.37–0.77 vs. ≥ 30: RR, 0.65; 95% CI, 0.55–0.77) or with less follow-up time (≤ 1 year: RR, 0.57; 95% CI, 0.42–0.79 vs. > 1 year: RR, 0.64; 95% CI, 0.53–0.78). Conclusions Complementary CPAP therapy reduces the risk of AF recurrence in OSA patients with rhythm control strategies. In addition to weight control and early AF intervention, CPAP compliance should be recommended along with periodic adjustments as necessary.