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