Arrhythmias and conduction disturbance
Meta-Analysis of Obstructive Sleep Apnea as Predictor of Atrial Fibrillation Recurrence After Catheter Ablation

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The association between obstructive sleep apnea (OSA) and atrial fibrillation (AF) is strong and is now well established. However, studies on the role of OSA on AF recurrence after catheter ablation have yielded conflicting results. The aim of the present study was to investigate the role of OSA on AF recurrence after catheter-based pulmonary vein isolation. We performed a data search on the PubMed, Web of Science, and the Cochrane databases for studies published by August 2010. In addition, we manually searched the conference proceedings of the European Society of Cardiology, American College of Cardiology, and American Heart Association for related abstracts. After the initial search returned 402 reports, we identified 6 studies with a total of 3,995 patients that met our inclusion criteria. Overall, patients with OSA have a 25% greater risk of AF recurrence after catheter ablation than those without OSA (risk ratio 1.25, 95% confidence interval 1.08 to 1.45, p = 0.003). Subgroup analysis showed that OSA diagnosed using polysomnography is a strong predictor of AF recurrence (risk ratio 1.40, 95% confidence interval 1.16 to 1.68, p = 0.0004) but not when OSA was diagnosed using the Berlin questionnaire (risk ratio 1.07, 95% confidence interval 0.91 to 1.27, p = 0.39). In conclusion, patients with OSA have significantly greater AF recurrence rates after pulmonary vein isolation. In addition to other factors, a diagnosis of OSA merits special consideration when evaluating patients for catheter-based AF ablation.

Section snippets

Methods

We performed the present analysis according to the guidelines of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.3 Two investigators (C.N., T.L.) performed a search independently using the on-line databases of PubMed, Web of Science, and Cochrane Central Register of Controlled Trials, using the keywords “sleep apnea,” “sleep disordered breathing,” and “atrial fibrillation” for studies published before August 2010. In addition, we also manually searched the conference

Results

A flow diagram of the data search and study selection is presented in Figure 1. A total of 402 studies were found using our search criteria. We identified 202 duplicate studies, which were discarded. The remaining 200 abstracts were screened further, and we excluded 190 studies, because they were either unrelated, irrelevant, review articles or animal studies. Ten full-text studies were then retrieved for detailed evaluation. Of the 10 studies, 47, 8, 9, 10 did not meet the inclusion criteria

Discussion

In the present comprehensive meta-analysis, we have demonstrated that OSA is associated with an increased risk of AF recurrence after catheter ablation (RR 1.25, 95% CI 1.08 to 1.45, p = 0.003) with moderate heterogeneity across individual studies (p = 0.08 and I2 = 49%). The study population size and follow-up period could be potential sources of heterogeneity on sensitivity analysis.

The BQ was previously validated as a tool to identify OSA and has a sensitivity of 86%, a specificity of 77%,

References (30)

  • M.L. Smith et al.

    Role of hypoxemia in sleep apnea-induced sympathoexcitation

    J Auton Nerv Syst

    (1996)
  • T. Liu et al.

    Association between C-reactive protein and recurrence of atrial fibrillation after successful electrical cardioversion: a meta-analysis

    J Am Coll Cardiol

    (2007)
  • T. Liu et al.

    Meta-analysis of association between C-reactive protein and immediate success of electrical cardioversion in persistent atrial fibrillation

    Am J Cardiol

    (2008)
  • A.S. Gami et al.

    Association of atrial fibrillation and obstructive sleep apnea

    Circulation

    (2004)
  • D.F. Stroup et al.

    Meta-analysis of observational studies in epidemiology: a proposal for reportingMeta-analysis Of Observational Studies in Epidemiology (MOOSE) group

    JAMA

    (2000)

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