Tanaka Nobuaki, Okada Masato, Tanaka Koji, Hirao Yuko, Miyazaki Naoko, Iwasa Kohei, Koyama Yasushi, Iwanaga Yoshitaka, Watanabe Heitaro, Fujii Kenshi, Iwakura Katsuomi, Sakata Yasushi, Okamura Atsunori
Cardiovascular Center, Sakurabashi Watanabe Advanced Healthcare Hospital Osaka Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan.
J Am Heart Assoc. 2025 May 20;14(10):e038742. doi: 10.1161/JAHA.124.038742. Epub 2025 May 15.
Obstructive sleep apnea represents an arrhythmia recurrence risk following catheter ablation of atrial fibrillation (AF). Continuous positive airway pressure (CPAP) therapy may reduce recurrence, but individual adherence to CPAP varies, potentially leading to inconsistent results across studies.
We analyzed the impact of CPAP adherence on AF recurrence after catheter ablation in patients with severe obstructive sleep apnea (apnea-hypopnea index ≥30). Of 1864 consecutive patients undergoing an index catheter ablation of AF, those with severe obstructive sleep apnea were enrolled in this study. Recurrence rates were compared between patients with and without long-term CPAP adherence (>1-year use). CPAP use was monitored via telemonitoring and outpatient follow-ups. Among 466 patients, 157 (33.7%) adhered to CPAP long-term, reducing apnea-hypopnea index from 37.7±15.3 to 3.9±3.1 ( <0.0001). While AF recurrence rates within the first year post-catheter ablation were similar between the groups, very late recurrence (beyond 1 year) was significantly lower in patients with long-term CPAP treatment than in those without (7.6% versus 21.6%, log-rank =0.0002). Even after adjusting for potential confounders, long-term CPAP treatment was associated with a lower risk of very late recurrence (adjusted hazard ratio, 0.30 [95% CI, 0.14-0.57]).
In patients with severe obstructive sleep apnea at baseline, AF recurrence rates within 1-year postablation were similar regardless of CPAP adherence. However, long-term CPAP therapy was associated with a reduced AF recurrence rate in the subsequent period.
阻塞性睡眠呼吸暂停是心房颤动（AF）导管消融术后心律失常复发的一个风险因素。持续气道正压通气（CPAP）治疗可能会降低复发率，但个体对CPAP的依从性各不相同，这可能导致各研究结果不一致。
我们分析了严重阻塞性睡眠呼吸暂停（呼吸暂停低通气指数≥30）患者导管消融术后CPAP依从性对AF复发的影响。在1864例接受首次AF导管消融的连续患者中，纳入了那些患有严重阻塞性睡眠呼吸暂停的患者。比较了长期（使用超过1年）坚持和未坚持CPAP治疗的患者的复发率。通过远程监测和门诊随访来监测CPAP的使用情况。在466例患者中，157例（33.7%）长期坚持使用CPAP，呼吸暂停低通气指数从37.7±15.3降至3.9±3.1（P<0.0001）。虽然导管消融术后第一年内两组的AF复发率相似，但长期接受CPAP治疗的患者极晚期（超过1年）复发率显著低于未接受CPAP治疗的患者（7.6%对21.6%，对数秩检验P=0.0002）。即使在调整了潜在混杂因素后，长期CPAP治疗与极晚期复发风险较低相关（调整后风险比为0.30[95%CI，0.14 - 0.57]）。
基线时患有严重阻塞性睡眠呼吸暂停的患者，消融术后1年内AF复发率与是否坚持CPAP治疗无关。然而，长期CPAP治疗与随后时期AF复发率降低相关。
