Obstructive sleep apnea and its management in patients with atrial fibrillation: An International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

Faulx, Michael D.; Mehra, Reena; Geovanini, Glaucylara Reis; Ando, Shin-ichi; Arzt, Michael; Drager, Luciano F.; Fu, Michael; Hoyos, Camilla M.; Hai, Jo Jo; Hwang, Juey‐Jen; Kimoff, John; Lee, Pei-Lin; Mediano, Olga; Patel, Sanjay R.; Peker, Yüksel; Pépin, Jean; Sánchez‐de‐la‐Torre, Manuel; Sériès, Frédéric; Stadler, Stefan; Strollo, Patrick J.; Tahrani, Abd; Thunström, Erik; Yamauchi, Motoo; Redline, Susan; Phillips, Craig L.

doi:10.1016/j.ijcha.2022.101085

Cited by 7 publications

(11 citation statements)

References 38 publications

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“…Addressing sleep apnea offers a modifiable avenue for therapeutic intervention, with potential benefits for AF management [66]. Emerging evidence suggests that treating OSA can lead to improved AF control and potentially reduce AF recurrence rates [67]. Notably, OSA treatment prior to ablation has been linked to decreased AF recurrence [68].…”

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

“…The cornerstone of OSA treatment is continuous positive airway pressure (CPAP) therapy, which has demonstrated efficacy in both sleep apnea management and enhancing AF control [66]. Optimizing OSA treatment can enhance the outcomes of AF therapies by improving overall AF management [67].…”

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

“…Considering that OSA contributes to autonomic and metabolic disruptions and cardiovascular disorders, its treatment holds therapeutic implications for AF management [66]. However, while some international cardiologists advocate for OSA treatment in AF management, the relationship still lacks universal consensus [67]. Additional research is required to solidify the connection between OSA treatment and the efficacy of AF therapies [66].…”

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

“…Presently, CPAP's impact has been mainly explored in the context of reducing OSA-associated morbidity and mortality [70]. While varied in results, these studies have indicated potential benefits in AF endpoints with CPAP treatment for OSA [67]. A survey of AF experts underscores the consensus that randomized controlled trials investigating OSA treatment in AF patients are essential [67].…”

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

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Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Ifiora,

Agudosi,

Ekpemiro

et al. 2023

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Background: AF's global prevalence underscores its significance as a cardiac rhythm disorder that disrupts atrial activity, impairing normal cardiac function. Over five decades of study have illuminated the pathophysiological mechanisms underlying AF, including insights into re-entrant waves and macro-reentrant circuits. The emergence of non-uniform conduction patterns and bidirectional block regions has further enriched our understanding. Risk factors contributing to AF development encompass cardiovascular conditions, advanced age, and atrial structural changes. With its implications on stroke risk and cardiovascular health, AF has become a growing public health concern. The focus on AF epidemiology has expanded, with attention on the relationship between left atrial size and AF development. Individuals with larger left atria exhibit a heightened risk. Additionally, the elevated stroke risk associated with AF has been consistently documented. To optimize clinical management, distinctions are drawn between chronic and paroxysmal AF, as well as the presence of structural heart disease. Mapping techniques have revealed insights into "atrial remodeling" and AF pathology. In managing AF, controlling heart rate, preventing clot formation, and restoring sinus rhythm are principal objectives. This article categorizes AF into acute, chronic, stable, or unstable forms, tailoring management approaches accordingly. While pharmacological interventions have shown efficacy, their limitations drive the exploration of nonpharmacological strategies. Approaches range from medications to cardioversion, including electrical and pharmacological methods. Objective: This paper aimed to provide a comprehensive exploration of non-pharmacological approaches to AF management. Methodology: This paper employed a structured methodology. This method involved a literature review, data synthesis, and critical analysis. During the literature review phase, we systematically searched electronic databases (PubMed, MEDLINE, Embase, and Google Scholar) for studies published from 1960 to 2023. Specific keywords and phrases such as "atrial fibrillation," "non-pharmacological interventions," "electrical cardioversion," "catheter ablation," "lifestyle modifications," "autonomic modulation," "left atrial appendage closure," and "exercise" were used. Our inclusion criteria encompassed studies addressing various non-pharmacological approaches for AF management, including observational studies and randomized controlled trials. Result: The initial stage of our study involved the identification of a substantial number of relevant studies. We conducted a thorough literature search across multiple databases, using specific search terms and criteria relevant to our research topic. This comprehensive search yielded a total of 1,200 studies. After applying these stringent filtering criteria, we were left with 350 studies. To further refine our final sample and categorize the studies according to type, we conducted a detailed review of the remaining 350 studies. We categorized them into various types based on study design, methodology, and focus. We then also excluded studies with duplicate ideas and finally included 103 studies that addressed the objective of our research plan. (See reference list [1-103]). Conclusion: This reviewed a number of non-pharmacological approaches including electrical cardioversion, catheter ablation, lifestyle modifications, autonomic modulation, left atrial appendage closure, and exercise, the paper delves into each method's advantages, potential risks, techniques, and efficacy. By offering this extensive overview, the article contributes to the expanding repository of knowledge on non-pharmacological approaches for AF management. These approaches offer potential for unique management of atrial fibrillations or in addition to pharmacologic management, may improve patient survivability or reduce complication outcomes. In the management of Atrial fibrillation, choice between rhythm and rate control, lifestyle modifications, and patient adherence to treatment plans are critical factors influencing outcomes are factors to consider. Emerging therapies offer promise, but timely diagnosis, individualized care, and ongoing monitoring remain essential to improving AF patients' overall prognosis.

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Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

Section: Treating Sleep Apnea and Sleep Disorders In Atrial Fibrillationmentioning

confidence: 99%

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Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Ifiora,

Agudosi,

Ekpemiro

et al. 2023

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“…However, recent randomized controlled trials (RCTs) did not con rm that CPAP could reduce the rate of AF recurrence [13,14]. In addition, a recent survey by the International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) also found controversy among cardiologists regarding the application of CPAP in AF patients comorbid with OSA [15]. Because of these inconsistent conclusions, we further investigated the effect of CPAP therapy on the recurrence of AF after DCCD or RFCA and the possible in uencing factors.…”

Section: Introductionmentioning

confidence: 99%

Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Wang

Luo

Huang

et al. 2022

Preprint

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Background: A higher incidence of atrial fibrillation is linked to obstructive sleep apnea. The effects of continuous positive airway pressure on atrial fibrillation have been studied in observational studies and randomized controlled trials. We conducted this meta-analysis to assess the effect of continuous positive airway pressure therapy on the recurrence of atrial fibrillation after conversion to sinus rhythm in obstructive sleep apnea patients. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane, and Web of Science databases from inception till October 2022. We included cohort studies and randomized controlled trials containing the recurrent situation of atrial fibrillation after catheter ablation or direct current cardioversion with and without continuous positive airway pressure therapy. The random-effects model was used to evaluate the odds ratios (OR) and confidence intervals (CI). I2 was used to assess the heterogeneity. Results: 8 studies with a total of 1372 obstructive sleep apnea patients met the inclusion criteria. Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 57% (OR=0.43, 95% CI 0.29-0.64, I2=38.0%). Subgroup analysis showed that the protective effect was more significant in groups with a higher burden of atrial fibrillation (OR 0.294 vs. 0.622, 95% CI 0.164-0.524 vs. 0.376-1.027, p=0.055) and with more hypertension patients (OR 0.272 vs. 0.550, 95% CI 0.165-0.449 vs. 0.329-0.922, p=0.054). Age, body mass index, severity of OSA, and therapy compliance had no significant effect on the recurrence of atrial fibrillation. Conclusions: Continuous positive airway pressure therapy decreased the atrial fibrillation recurrence rate. The severity of atrial fibrillation and hypertension both had an impact on it. Studies focused on the effects of the severity of OSA and treatment compliance, and more randomized controlled trials are needed in the future.

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