Fan Jun, Tan Cui-Jin, Cao Li-Li, Luo Shao-Ling, Sun Shao-Xi, Wang Shao-Hua, Li Wei-Jie, Pan Yi-Chao, Wu Tian-Yuan, Dai Qi-Shan, Liu Zhen, Liu Jian, Yu Bing-Bo
Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, China.
The Third School of Clinical Medicine Southern Medical University, Guangzhou, China.
BMC Cardiovasc Disord. 2025 Jul 4;25(1):473. doi: 10.1186/s12872-025-04846-x.
While obstructive sleep apnea (OSA) is recognized as a risk factor for atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI), the preventive efficacy of continuous positive airway pressure (CPAP) remains conflicting across studies, necessitating further validation.
We conducted a meta-analysis integrating data from Web of Science, PubMed, and OVID databases to evaluate the association between OSA and AF recurrence post-PVI, as well as the effect of continuous positive airway pressure (CPAP).
OSA patients demonstrated a significantly elevated risk of AF recurrence compared to controls (RR = 1.67, 95% CI:1.52-1.83). Stratified analyses revealed differential effects based on left atrial (LA) size: OSA patients without significant LA enlargement exhibited an risk ration (RR) of 2.13 (95% CI:1.63-2.79), and those with enlarged LA size showed an RR of 1.78 (95% CI:1.46-2.17). Subgroup stratification by AF type revealed no significant impact of OSA on recurrence in studies with paroxysmal AF only (RR = 1.15, 95% CI:0.74-1.77), whereas an elevated RR of 1.7 (95% CI:1.54-2.11) emerged in studies combining paroxysmal and persistent AF populations. CPAP therapy reduced AF recurrence risk overall (RR = 0.6, 95% CI:0.52-0.70), but this benefit varied by LA size comparability (no LA difference: RR = 0.58, 95% CI:0.33-1.01; significant LA difference: RR = 0.61, 95% CI:0.49-0.76). CPAP efficacy was evident in mixed AF populations (RR = 0.56, 95% CI:0.48-0.67) but absent in paroxysmal AF cohorts (RR = 1.3, 95% CI:0.71-1.50).
This meta-analysis confirms that OSA is an independent predictor of AF recurrence following PVI. While CPAP therapy confers a general protective benefit, it does not have an effect in patients with paroxysmal AF or in those without left atrial enlargement. These results highlight the necessity of phenotypic stratification when designing and implementing CPAP-based preventive strategies.
虽然阻塞性睡眠呼吸暂停（OSA）被认为是肺静脉隔离（PVI）后房颤（AF）复发的一个危险因素，但持续气道正压通气（CPAP）的预防效果在各项研究中仍存在争议，需要进一步验证。
我们进行了一项荟萃分析，整合了来自科学网、PubMed和OVID数据库的数据，以评估OSA与PVI后AF复发之间的关联，以及持续气道正压通气（CPAP）的效果。
与对照组相比，OSA患者房颤复发风险显著升高（RR = 1.67，95% CI：1.52 - 1.83）。分层分析显示，根据左心房（LA）大小存在不同影响：左心房无明显增大的OSA患者风险比（RR）为2.13（95% CI：1.63 - 2.79），左心房增大的患者RR为1.78（95% CI：1.46 - 2.17）。按房颤类型进行亚组分层显示，在仅涉及阵发性房颤的研究中，OSA对复发无显著影响（RR = 1.15，95% CI：0.74 - 1.77），而在合并阵发性和持续性房颤人群的研究中，RR升高至1.7（95% CI：1.54 - 2.11）。CPAP治疗总体上降低了房颤复发风险（RR = 0.6，95% CI：0.52 - 0.70），但这种益处因左心房大小的可比性而异（左心房无差异：RR = 0.58，95% CI：0.33 - 1.01；左心房有显著差异：RR = 0.61，95% CI：0.49 - 0.76）。CPAP在混合性房颤人群中疗效明显（RR = 0.56，95% CI：0.48 - 0.67），但在阵发性房颤队列中无效（RR = 1.3，95% CI：0.71 - 1.50）。
这项荟萃分析证实，OSA是PVI后房颤复发的独立预测因素。虽然CPAP治疗具有普遍的保护作用，但对阵发性房颤患者或左心房未增大的患者无效。这些结果突出了在设计和实施基于CPAP的预防策略时进行表型分层的必要性。
