TY - JOUR
T1 - Impact of CPAP on the Atrial Fibrillation Substrate in Obstructive Sleep Apnea
T2 - The SLEEP-AF Study
AU - Nalliah, Chrishan J.
AU - Wong, Geoffrey R.
AU - Lee, Geoffrey
AU - Voskoboinik, Aleksandr
AU - Kee, Kirk
AU - Goldin, Jeremy
AU - Watts, Troy
AU - Linz, Dominik
AU - Parameswaran, Ramanathan
AU - Sugumar, Hariharan
AU - Prabhu, Sandeep
AU - McLellan, Alex
AU - Ling, Liang Han
AU - Joseph, Stephen A.
AU - Morton, Joseph B.
AU - Kistler, Peter
AU - Sanders, Prashanthan
AU - Kalman, Jonathan M.
N1 - Funding Information:
For this work, Dr Nalliah received the Eric Prystowsky Fellows Clinical Research Award, Heart Rhythm Society, May 2020, and the Ralph Reader Young Investigator Prize of the Cardiac Society of Australia and New Zealand, December 2020; and he is supported also by the National Heart Foundation and a Viertel Charitable Foundation Clinical Investigator Award. Dr Voskoboinik is supported by an NHMRC EL1 Investigator Grant and an NHF Early Career Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/7
Y1 - 2022/7
N2 - Background: Observational studies report that obstructive sleep apnea (OSA) is associated with an increasingly remodeled atrial substrate in atrial fibrillation (AF). However, the impact of OSA management on the electrophysiologic substrate has not been evaluated. Objectives: In this study, the authors sought to determine the impact of OSA management on the atrial substrate in AF. Methods: We recruited 24 consecutive patients referred for AF management with at least moderate OSA (apnea-hypopnea index [AHI] ≥15). Participants were randomized in a 1:1 ratio to commence continuous positive airway pressure (CPAP) or no therapy (n = 12 CPAP; n = 12 no CPAP). All participants underwent invasive electrophysiologic study (high-density right atrial mapping) at baseline and after a minimum of 6 months. Outcome variables were atrial voltage (mV), conduction velocity (m/s), atrial surface area <0.5 mV (%), proportion of complex points (%), and atrial effective refractory periods (ms). Change between groups over time was compared. Results: Clinical characteristics and electrophysiologic parameters were similar between groups at baseline. Compliance with CPAP therapy was high (device usage: 79% ± 19%; mean usage/day: 268 ± 91 min) and resulted in significant AHI reduction (mean reduction: 31 ± 23 events/h). There were no differences in blood pressure or body mass index between groups over time. At follow-up, the CPAP group had faster conduction velocity (0.86 ± 0.16 m/s vs 0.69 ± 0.12 m/s; P (time × group) = 0.034), significantly higher voltages (2.30 ± 0.57 mV vs 1.94 ± 0.72 mV; P < 0.05), and lower proportion of complex points (8.87% ± 3.61% vs 11.93% ± 4.94%; P = 0.011) compared with the control group. CPAP therapy also resulted in a trend toward lower proportion of atrial surface area <0.5 mV (1.04% ± 1.41% vs 4.80% ± 5.12%; P = 0.065). Conclusions: CPAP therapy results in reversal of atrial remodeling in AF and provides mechanistic evidence advocating for management of OSA in AF.
AB - Background: Observational studies report that obstructive sleep apnea (OSA) is associated with an increasingly remodeled atrial substrate in atrial fibrillation (AF). However, the impact of OSA management on the electrophysiologic substrate has not been evaluated. Objectives: In this study, the authors sought to determine the impact of OSA management on the atrial substrate in AF. Methods: We recruited 24 consecutive patients referred for AF management with at least moderate OSA (apnea-hypopnea index [AHI] ≥15). Participants were randomized in a 1:1 ratio to commence continuous positive airway pressure (CPAP) or no therapy (n = 12 CPAP; n = 12 no CPAP). All participants underwent invasive electrophysiologic study (high-density right atrial mapping) at baseline and after a minimum of 6 months. Outcome variables were atrial voltage (mV), conduction velocity (m/s), atrial surface area <0.5 mV (%), proportion of complex points (%), and atrial effective refractory periods (ms). Change between groups over time was compared. Results: Clinical characteristics and electrophysiologic parameters were similar between groups at baseline. Compliance with CPAP therapy was high (device usage: 79% ± 19%; mean usage/day: 268 ± 91 min) and resulted in significant AHI reduction (mean reduction: 31 ± 23 events/h). There were no differences in blood pressure or body mass index between groups over time. At follow-up, the CPAP group had faster conduction velocity (0.86 ± 0.16 m/s vs 0.69 ± 0.12 m/s; P (time × group) = 0.034), significantly higher voltages (2.30 ± 0.57 mV vs 1.94 ± 0.72 mV; P < 0.05), and lower proportion of complex points (8.87% ± 3.61% vs 11.93% ± 4.94%; P = 0.011) compared with the control group. CPAP therapy also resulted in a trend toward lower proportion of atrial surface area <0.5 mV (1.04% ± 1.41% vs 4.80% ± 5.12%; P = 0.065). Conclusions: CPAP therapy results in reversal of atrial remodeling in AF and provides mechanistic evidence advocating for management of OSA in AF.
KW - atrial fibrillation
KW - continuous positive airway therapy
KW - obstructive sleep apnea
KW - reverse atrial remodeling
UR - http://www.scopus.com/inward/record.url?scp=85134194603&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2022.04.015
DO - 10.1016/j.jacep.2022.04.015
M3 - Article
C2 - 35863812
AN - SCOPUS:85134194603
SN - 2405-500X
VL - 8
SP - 869
EP - 877
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 7
ER -