Preoperative Treatment of Obstructive Sleep Apnea With Positive Airway Pressure is Associated With Decreased Incidence of Atrial Fibrillation After Cardiac Surgery

Jim K. Wong, Edward R. Mariano, Anthony G. Doufas, Megan J. Olejniczak, Clete A. Kushida

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective Based on clinical studies in the nonsurgical population that positive airway pressure (PAP) therapy for patients with obstructive sleep apnea (OSA) provides benefits for those with atrial fibrillation, the authors tested the hypothesis that PAP in patients with OSA reduces the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery. Design Retrospective analysis. Setting Single-center university hospital. Participants The study comprised 192 patients in sinus rhythm preoperatively who were undergoing nontransplantation or ventricular assist device implantation cardiac surgery requiring cardiopulmonary bypass but not requiring systemic circulatory arrest, with documented PAP adherence from January 2008 to October 2015. Interventions Retrospective review of medical records. Measurements and Main Results POAF was defined as atrial fibrillation requiring therapeutic intervention. Of the 192 patients with OSA, 104 (54%) were documented to be PAP-adherent and 88 (46%) were reported to be PAP-nonadherent. Among PAP users, 49 (47%) developed POAF; among PAP nonusers, 59 (66%) developed POAF. The adjusted hazard ratio was 0.59 (95% confidence interval 0.40-0.86, p<0.01). No differences were observed in intensive care unit length of stay (4.0±3.4 days for PAP-adherent group v 5.0±6.2 days for PAP-nonadherent group; p = 0.22) or hospital length of stay (10.7±6.6 days for PAP-adherent group v 10.9±7.3 days for PAP nonadherent group; p = 0.56). A lower median postoperative creatinine rise was observed in PAP-adherent patients (18.2% [8.3%-37.5%) v 31.3% [13.3%-50%]; p< 0.01). Conclusion Preoperative PAP use in patients with OSA was associated with a decreased rate of POAF after cardiac surgery.

Original languageEnglish (US)
Pages (from-to)1250-1256
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume31
Issue number4
DOIs
StatePublished - Aug 2017

Keywords

  • cardiac surgery
  • obstructive sleep apnea
  • positive airway pressure
  • postoperative atrial fibrillation

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