Shukla Ashish, Aizer Anthony, Holmes Douglas, Fowler Steven, Park David S, Bernstein Scott, Bernstein Neil, Chinitz Larry
Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York.
Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York.
JACC Clin Electrophysiol. 2015 Mar-Apr;1(1-2):41-51. doi: 10.1016/j.jacep.2015.02.014. Epub 2015 Apr 20.
This study aimed to evaluate the cumulative effect of treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) on atrial fibrillation (AF) recurrence.
OSA is a known predictor for onset and recurrence of AF. The effect of treatment with CPAP on AF recurrence has been evaluated in small studies with varied outcomes.
We searched MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Trials Register for relevant studies. Evaluation of AF recurrence in CPAP users and nonusers in patients with OSA was the primary outcome evaluated in this study. The secondary outcome was evaluation of AF recurrence in CPAP users and nonusers after pulmonary vein isolation (PVI).
Seven prospective cohort studies with a total of 1,087 patients met the inclusion criteria. Across all patient groups, the use of CPAP was associated with a significant reduction in AF recurrence (relative risk: 0.58, 95% confidence interval: 0.51 to 0.67; heterogeneity chi-square p = 0.91, I = 0%). The beneficial effect of CPAP use was statistically significant in both groups of patients: those who underwent catheter ablation with PVI and those who did not undergo ablation and were managed medically. No other study covariates had any significant association with these outcomes of AF reduction.
The use of CPAP is associated with significant reduction in recurrence of AF in patients with OSA. This effect remains consistent and similar across patient populations irrespective of whether they undergo PVI.
本研究旨在评估持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停（OSA）对房颤（AF）复发的累积影响。
OSA是AF发病和复发的已知预测因素。CPAP治疗对AF复发的影响已在一些结果各异的小型研究中进行了评估。
我们检索了MEDLINE、EMBASE、CINAHL、谷歌学术、Cochrane系统评价数据库和Cochrane试验注册库以查找相关研究。本研究评估的主要结果是OSA患者中使用CPAP和未使用CPAP者的AF复发情况。次要结果是肺静脉隔离（PVI）后使用CPAP和未使用CPAP者的AF复发情况。
7项前瞻性队列研究共1087例患者符合纳入标准。在所有患者组中，使用CPAP与AF复发显著降低相关（相对风险：0.58，95%置信区间：0.51至0.67；异质性卡方检验p = 0.91，I² = 0%）。在两组患者中，使用CPAP的有益效果均具有统计学意义：接受PVI导管消融的患者和未接受消融而是接受药物治疗的患者。没有其他研究协变量与这些AF减少的结果有任何显著关联。
使用CPAP与OSA患者AF复发显著降低相关。无论患者是否接受PVI，这种效果在不同患者群体中均保持一致且相似。
