Effect of Continuous Positive Airway Pressure on Arrhythmia in Atrial Fibrillation and Sleep Apnea: A Randomized Controlled Trial
Gunn Marit Traaen, Lars Aakerøy, Tove-Elizabeth Hunt, Britt Øverland, Christina Bendz, Lars Øivind Sande, Svend Aakhus, Morten Wang Fagerland, Sigurd Steinshamn, Ole‐Gunnar Anfinsen, Richard J. Massey, Kaspar Broch, Thor Ueland, Harriet Akre, Jan Pål Loennechen, Lars Gullestad
Abstract
Abstract Rationale Sleep apnea (SA) is highly prevalent in patients with atrial fibrillation (AF), and both conditions are associated with adverse cardiovascular outcomes. Objectives To determine the effect of continuous positive airway pressure (CPAP) on AF burden. Methods This open-label, parallel-group, randomized controlled trial included patients with paroxysmal AF and moderate to severe SA (apnea–hypopnea index ⩾15). A computerized system randomized eligible patients (1:1) to 5 months’ treatment with CPAP plus usual care (CPAP, n = 55) or usual care alone (control, n = 54). The outcome assessment was blinded. The planned primary outcome was the difference between CPAP treatment and control groups in change of AF burden (percentage of time in AF) as measured by implantable loop recorder. Measurements and Main Results A total of 579 patients with paroxysmal AF had respiratory polygraphy, of whom 244 (42%) had moderate to severe SA. Of these, 158 (65%) participated in the CPAP run-in period, of whom 39 (25%) patients did not tolerate the treatment. A total of 108 patients were available for the primary analysis. The mean time in AF decreased from 5.6% at baseline to 4.1% during the last 3 months of CPAP intervention and from 5.0% to 4.3% in the control group. The adjusted between-group difference at follow-up was −0.63 (95% confidence interval, −2.55 to 1.30) percentage points (P = 0.52). Seven serious adverse events (13%) occurred in the CPAP group, and two (4%) occurred in the control group. Conclusions In patients with paroxysmal AF and SA, treatment with CPAP did not result in a statistically significant reduction in the burden of AF.Clinical trial registered with www.clinicaltrials.gov (NCT02727192).