The Impact of Continuous Positive Airway Pressure Therapy on the Recurrence of Atrial Fibrillation in Patients with Obstructive Sleep Apnea after pulmonary vein isolation

Background Despite the recognized risk of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) in patients with obstructive sleep apnea (OSA), the effect of continuous positive airway pressure (CPAP) remains inconsistent across studies, necessitating further examination. Methods Utilizing databases encompassing Web of Science, Pubmed and OVID, we implemented a meta-analysis dedicated to investigating the role of OSA in post-PVI AF recurrence and the preventative properties of CPAP. Results Our meta-analysis of OSA patients undergoing PVI suggests an AF recurrence risk with a RR (risk ratio) of 1.67 (95% CI: 1.52-1.83). For patients with no atrial size difference, the risk is RR=2.13 (95% CI: 1.63-2.79), and with size difference, it’s RR=1.78 (95% CI: 1.46-2.17). Diagnoses from the Berlin questionnaire and polysomnography yielded RRs of 1.71 (95% CI: 1.37-2.14) and 1.75 (95% CI: 1.40-2.18), respectively. Non-CPAP usage increases AF recurrence risk by 67% and especially in cases of significant atrial size difference (RR=1.63, 95%CI:1.32-2.03). Conversely, when atrial size difference is absent, the impact of CPAP appears to be insignificant (RR=1.22, 95%CI: 0.98-3.02). Co-existence of paroxysmal and non-paroxysmal AF indicates a significant CPAP effect (RR=1.78, 95% CI: 1.50-2.09), contrary to one study on paroxysmal AF patients (RR=1.3, 95%CI: 0.71-1.50). Conclusion Our meta-analysis found a significant risk of AF recurrence in patients with OSA following PVI. However, OSA had an insignificant impact on AF recurrence in paroxysmal AF patients. Non-CPAP usage generally increased recurrence risk. Yet, in subgroups without prominent atrial size difference and paroxysmal AF, CPAP’s influence was not significant. Keywords: CPAP; Atrial Fibrillation; Obstructive Sleep Apnea; Pulmonary vein isolation ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by Guangzhou City Science and Technology Program (No.202102021100) to Dr. Fan. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of the Second Affiliated Hospital of South China University of Technology has granted approval for the conduct of this study. The privacy and confidentiality of the participants were respected and protected throughout the research process, and all aspects of the study complied with the principles of the Declaration of Helsinki. The present study was registered on the Prospero website (Registration number: CRD42023452039, ) in accordance with the guidelines specified by the Meta-analysis of observational studies in epidemiology (MOOSE) group. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes If authorized by the author, the data may be available upon request.