Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University.
Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
Medicine (Baltimore). 2021 Apr 16;100(15):e25438. doi: 10.1097/MD.0000000000025438.
Obstructive sleep apnea (OSA) is correlated with atrial fibrillation (AF). Over the past decade, there has been an increasing interest in the relationship between OSA with continuous positive airway pressure (CPAP) and progression or recurrence of AF.
This investigation was an analysis of studies searched in the Cochrane Library, PubMed, EMBASE, EBSCO, OVID, and Web of Science databases from inception to July 2020 to evaluate the recurrence or progression of AF in CPAP users, CPAP nonusers, and patients without OSA.
Nine studies with 14,812 patients were recruited. CPAP therapy reduced the risk of AF recurrence or progression by 63% in a random-effects model (24.8% vs 40.5%, risk ratio [RR] = 0.70, 95% confidence interval [CI] = 0.57-0.85, P = .035). Compared with non-OSA patients, AF recurrence or progression was much higher in CPAP nonusers (40.6% vs 21.1%, RR = 1.70, 95% CI = 1.19-2.43, P = .000). However, AF recurrence or progression in the CPAP group was similar to that in the non-OSA group (24.0% vs 21.1%, RR = 1.13, 95% CI = 0.87-1.47, P = .001). Begg correlation test and Egger regression test revealed no publication bias in this analysis.
OSA is a salient factor in the progression or recurrence of AF. CPAP therapy for OSA may contribute to reduction of AF in patients for whom radiofrequency ablation or direct current cardioversion is not performed.
The protocol for this meta-analysis was registered on PROSPERO with a registration No. CRD42019135229.
阻塞性睡眠呼吸暂停（OSA）与心房颤动（AF）有关。在过去的十年中，人们对 OSA 与持续气道正压通气（CPAP）之间的关系以及 AF 的进展或复发越来越感兴趣。
这项研究是对 2020 年 7 月前在 Cochrane 图书馆、PubMed、EMBASE、EBSCO、OVID 和 Web of Science 数据库中搜索到的研究进行的分析，以评估 CPAP 使用者、CPAP 非使用者和无 OSA 患者的 AF 复发或进展情况。
共纳入 9 项研究，14812 例患者。CPAP 治疗可使 AF 复发或进展的风险降低 63%（随机效应模型，24.8%比 40.5%，风险比[RR] = 0.70，95%置信区间[CI] = 0.57-0.85，P = 0.035）。与非 OSA 患者相比，CPAP 非使用者的 AF 复发或进展率更高（40.6%比 21.1%，RR = 1.70，95%CI = 1.19-2.43，P = 0.000）。然而，CPAP 组的 AF 复发或进展与非 OSA 组相似（24.0%比 21.1%，RR = 1.13，95%CI = 0.87-1.47，P = 0.001）。Begg 相关检验和 Egger 回归检验均表明，本分析无发表偏倚。
OSA 是 AF 进展或复发的重要因素。CPAP 治疗 OSA 可能有助于减少未行射频消融或直流电复律的患者的 AF。
本荟萃分析的方案已在 PROSPERO 上注册，注册号为 CRD42019135229。
