Patients at High Risk for Obstructive Sleep Apnea Are at Increased Risk for Atrial Fibrillation After Cardiac Surgery: A Cohort Analysis

Karimi, Nika; Kelava, Marta; Kothari, Perin; Zimmerman, Nicole M.; Gillinov, A. Marc; Duncan, Andra E.

doi:10.1213/ane.0000000000002852

Cited by 17 publications

(18 citation statements)

References 44 publications

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“…The incidence of POAF ranged from 8% to 67% in the patients with SDB and from 6% to 42% in the patients without SDB. The definition of atrial fibrillation was mostly based on findings from continuous electrocardiographic monitoring and electrocardiographic examination, while eight studies did not supply such information [ 20–21 , 23 , 26 , 29 , 31 , 36 , 39 ]. The most common surgery type was CABG, and eleven studies included other surgery types such as valve replacement [ 21 , 27 , 30–31 , 33–35 , 37–39 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Chen

Zhang

et al. 2022

Annals of Medicine

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Objective: An increasing number of studies suggest that sleep disordered breathing (SDB) may be associated with postoperative atrial fibrillation (POAF), but these studies present discrepant results. Thus, this meta-analysis aimed to synthesize the data associating SDB with POAF in patients who underwent cardiac surgery. Methods: A literature search was performed in the Scopus, PubMed, Web of Science, EMBASE, CENTRAL, Weipu, Wanfang Data, and China National Knowledge Infrastructure databases before August 2022. Data were extracted, and the strength of the relationship between SDB and the risk of POAF was evaluated using odds ratio (OR) and 95% confidence intervals (CIs). All statistical analysis was carried out using the Stata 12.0 software. Results: A total of 24 studies with 660,685 subjects were included in current meta-analysis. SDB was significantly associated with the risk of POAF in the patients who underwent cardiac surgery (OR = 1.49; 95% CI, 1.30–1.70; p < .001). Next subgroup analysis revealed that such association may be increased in the group with medical equipment-measured SDB (OR = 2.27; 95% CI, 1.59–3.23; p < .001), prospective studies (OR = 2.17; 95% CI, 1.55–3.03; p < .001), patients without a previous history of atrial fibrillation (OR = 2.04; 95% CI, 1.47–2.82; p < .001), and patients who received a coronary artery bypass graft (OR = 2.10; 95% CI, 1.45–3.05; p < .001). No publication bias was identified. Conclusion: The results of meta-analysis support that SDB may be associated with an increased risk of POAF in patients who had undergone cardiac surgery, and these results should be confirmed in more rigorously designed studies. KEY MESSAGES Patients with SDB who underwent cardiac surgery showed increased risk of POAF. The relationship between SDB and POAF should be explained with caution with the consideration of various covariate. The effect of pre-treatment of SDB on POAF should be examined in future.

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Section: Resultsmentioning

confidence: 99%

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Chen

Zhang

et al. 2022

Annals of Medicine

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“… 8 Other studies showed an increased risk of postoperative atrial fibrillation following cardiac surgery in patients with OSA. 9 , 30 However, these previous studies were most cross‐sectional, retrospective or prospective cohort studies, 8 and cannot overcome the influence of unmeasured confounders due to the nature of observational study. The present study found a causal effect of genetically predicted OSA on risk of atrial fibrillation using MR methods, which may control unmeasured confounders and reverse causation.…”

Section: Discussionmentioning

confidence: 99%

Causal Effect of Obstructive Sleep Apnea on Atrial Fibrillation: A Mendelian Randomization Study

Chen

Cai

et al. 2021

JAHA

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Background Obstructive sleep apnea (OSA) has shown to be associated with an increased risk of atrial fibrillation in observational studies. Whether this association reflect causal effect is still unclear. The aim of this study was to evaluate the causal effect of OSA on atrial fibrillation. Methods and Results We used a 2‐sample Mendelian randomization (MR) method to evaluate the causal effect of OSA on atrial fibrillation. Summary data on genetic variant‐OSA association were obtained from a recently published genome‐wide association studies with up to 217 955 individuals and data on variant‐atrial fibrillation association from another genome‐wide association study with up to 1 030 836 individuals. Effect estimates were evaluated using inverse‐variance weighted method. Other MR analyses, including penalized inverse‐variance weighted, penalized robust inverse‐variance weighted, MR‐Egger, simple median, weighted median, weighted mode‐based estimate and Mendelian Randomization Pleiotropy Residual Sum and Outlier methods were performed in sensitivity analyses. The MR analyses in both the fixed‐effect and random‐effect inverse‐variance weighted models showed that genetically predicted OSA was associated with an increased risk of atrial fibrillation (odds ratio [OR], 1.21; 95% CI, 1.12–1.31, P <0.001; OR, 1.21; 95% CI, 1.11–1.32, P <0.001) using 5 single nucleotide polymorphisms as the instruments. MR‐Egger indicated no evidence of genetic pleiotropy (intercept, −0.014; 95% CI, −0.033 to 0.005, P =0.14). Results were robust using other MR methods in sensitivity analyses. Conclusions This MR analysis found that genetically predicted OSA had causal effect on an increased risk of atrial fibrillation.

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“…81 Obstructive sleep apnea has been associated with many poor postoperative outcomes, including major adverse cardiac events, 82,83 reduced ejection fraction, 81 and especially postoperative atrial fibrillation. [83][84][85] Patients with OSA also tend to stay in the intensive care unit and hospital longer as well as present for readmission more often compared to patients without sleep apnea. 84,86 Patients with OSA may also require permanent pacemaker placement more frequently after valve surgery.…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

Knight

Subramanian

Sultan

et al. 2022

Semin Cardiothorac Vasc Anesth

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The concept of “prehabilitation” consists of screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgery, but may have profound impacts on outcomes particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of prehabilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision making. In this two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized by our center for cardiac presurgical care. This first installment will focus on the management of anemia, obesity, sleep apnea, diabetes, and cardiac rehabilitation prior to surgery. The second will focus on frailty, malnutrition, respiratory disease, alcohol and smoking cessation, and depression.

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Patients at High Risk for Obstructive Sleep Apnea Are at Increased Risk for Atrial Fibrillation After Cardiac Surgery: A Cohort Analysis

Abstract: Increasing risk for OSA, assessed by STOP-BANG, was associated with higher odds of postoperative atrial fibrillation, but not prolonged duration of mechanical ventilation or ICU length of stay.

Cited by 17 publications

References 44 publications

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Causal Effect of Obstructive Sleep Apnea on Atrial Fibrillation: A Mendelian Randomization Study

Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

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