A few months ago the skeptical cardiologist wrote a post which debunks the widespread notion that treatment of obstructive sleep apnea (OSA) with CPAP therapy is effective at lowering the risk of cardiovascular disease.
I concluded that there are no data supporting current recommendations to screen for OSA in patients with atrial fibrillation as there is no evidence that treating OSA improves cardiovascular outcomes or the frequency of atrial fibrillation:
Despite numerous flawed observational studies suggesting an association between sleep apnea and cardiovascular outcomes including atrial fibrillation the gold standard, high-quality RCT data do not clearly show that treatment of sleep apnea with CPAP improves cardiovascular outcomes.
From “Does Treating Sleep Apnea With CPAP Improve Cardiovascular Outcomes or Lower Risk of Atrial Fibrillation?”
At the recent American College of Cardiology Scientific Sessions in Washington, DC an abstract reported on still another randomized controlled trial showing zero benefit of CPAP in preventing the recurrence of atrial fibrillation in patients with OSA.
This study enrolled 111 consecutive patients with OSA and a history of atrial fibrillation and randomized them to either receive CPAP therapy or no CPAP therapy for OSA. All patients had an implantable loop recorder (ILR) implanted which allows the continuous recording and quantitative measurement of the amount (duration or burden) of atrial fibrillation.
CPAP therapy, even when the patient was highly compliant had no effect on the recurrence of atrial fibrillation (AFIB.)
Our data show no differences in AFIB recurrence of burden evaluated by ILR regardless of OSA presence or treatment with CPAP during a 2.5 years of follow-up
https://www.jacc.org/doi/abs/10.1016/S0735-1097(22)01011-7
This is a preliminary report and we look forward to seeing the full paper when published. But it adds to the prior negative studies I discussed in my prior post and emphasizes my bottom line recommendation:
Until good scientific evidence proves that treatment of OSA really does save lives, reduces heart failure, atrial fibrillation, or other important cardiovascular outcomes, widespread screening and marketing for the diagnosis and treatment of occult OSA other than for reducing snoring and daytime sleepiness should cease.
The skeptical cardiologist
Soporifically Yours,
-ACP
10 thoughts on “There is NO Benefit of CPAP Therapy for Obstructive Sleep Apnea in Preventing Atrial Fibrillation Recurrence”
The issue may be what, exactly, is “compliance” in CPAP usage. I usually awaken at least once during the night. I need a mask which covers both nose and mouth and the mask often slips so it leaks air in an annoying manner. If I can’t quickly fix this, I remove the mask so I can go back to sleep. The longer I’m able to keep the mask on, the more energetic I am in the morning. Isn’t good quality sleep associated with preventing heart disease or improving outcomes for those with heart disease? Everyone I know who uses or has used a CPAP machine has reported mask issues, and some have stopped using the machine altogether. I can certainly understand why no relationship between CPAP usage and afib reduction would be the outcome of randomized, controlled trials if CPAP users were using the equipment only a few hours each night. I live in a CCRC with about 800 residents in independent living so know a fair number who use, or used, CPAC machines at least occasionally. I think CPAP usage would be far more useful to patients if custom made masks which fit each face as well as possible were available; this seems doable at no great expense in this era of 3D printing.
I agree. The majority of patients I see who are diagnosed with OSA have given up on the therapy. In the study I quoted, however, the patients who were compliant (using CPAP >70% of sleep time) weren’t any less likely to have atrial fibrillation.
The effectiveness of any therapy is dependent on how well patients can tolerate it and it seems a minority of OSA patients. are able to tolerate CPAP.
Dr P
Kinda like sotalol for PAF: the effective dose (160 mg bid) isn’t tolerated and the tolerated dose (80 mg bid and most used, therefore) isn’t effective!
Haha. Exactly my feelings about sotalol!
Ddr P
Cardio Brothers from different mothers! ?
This is an interesting read considering the recommendation I do a sleep study.
Another question:
What are your thoughts on theWolf mini maze procedure?
I am preparing the paperwork to meet with Dr. Wolf.
Thank you.
Evangeline,
I am unaware of any published literature. which supports the claims made on Dr. Wolf’s website about the “Wolf mini-maze” procedure.
Specifically I doubt if this statement is proven. :
“Does the Wolf Mini-Maze procedure work? It’s been wildly successful. From the very beginning, the promise was clear. Now, Dr. Wolf has patients he sees every year, and he has studied some of them for weeks to make sure they do not have AFib. A decade after the procedure, they still don’t. They don’t take medication, they don’t need secondary procedures, and they don’t live with that constant stroke risk.”
There are certainly no references on the site to substantiate either the success rate or the reduction in stroke risk.
Beware wildly over-hyped procedures only performed by one individual.
Dr. Pearson
Thanks. Saved me another trip to the sleep lab! So is it saying that OSA is not associated with a greater burden of afib, or just that there is no difference in afib outcomes when OSA is treated with CPAP? Because if the latter, then it begs the questions how effective actually was the CPAP treatment and/or would someone with afib benefit from other treatments for OSA such as lifestyle changes. And in that case doesn’t necessarily mean OSA screening doesn’t have merit. So maybe back to the sleep lab lol
Jim
OSA is associated with higher risk of atrial fibrillation.
But if it were the cause , given that CPAP therapy substantially improves OSA, then CPAP therapy should reduce the risk of atrial fibrillation.
OSA is highly associated with obesity which is highly associated with afib. Treatment of obesity lowers recurrent rate of afib and rate of OSA
Focus should be on treating factors we know trigger atrial fibrillation like alcohol, obesity and lack of exercise rather than on trying to diagnose and treat mild to moderate cases of OSA to reduce AFIB recurrence.
Dr P
Alas, a marker, but not mediator!