Efficacy of Continuous Positive Airway Pressure Treatment in Patients with Cardiac Arrhythmia and Obstructive Sleep Apnea: What is the Evidence?

Asmaa M Abumuamar ； Tatyana Mollayeva ； Paul Sandor ； David Newman ； Kumaraswamy Nanthakumar ； Colin M Shapiro

《Clinical Medicine Insights: Therapeutics》 2017卷 (2017/12) Pp. 1-10-018

https://doi.org/10.1177/1179559X17734227

摘要

Numerous studies have been conducted in the past few decades on obstructive sleep apnea (OSA) as an independent risk factor for the development and progression of cardiac arrhythmia. Treatment with continuous positive airway pressure (CPAP) therapy lowers blood pressure, improves ejection fraction in patients with heart failure, and decreases the need of revascularization procedures in patients with coronary artery disease. However, there has been little published discussion regarding the effect of CPAP treatment on cardiac arrhythmia in patients with OSA. We aimed to summarize scientific evidence regarding the utility of CPAP treatment in managing the recurrence and severity of different types of cardiac arrhythmia. We retrieved articles published in English before December 2016, through database search of PubMed, CENTRAL, and Embase. All peer-reviewed experimental, comparative, and other observational studies focused on adults were considered eligible. Several studies documented positive changes in arrhythmia frequency and severity with CPAP application, irrespective of type of arrhythmia, study methodology, or setting. However, the available evidence on the impact of CPAP treatment on the frequency and severity of cardiac arrhythmia is limited by heterogeneity of data. The duration of CPAP application, compliance with treatment, and baseline severity of OSA and cardiac pathology are important confounding factors that influence the effect of CPAP treatment. We emphasize the need for agreement on a core set of relevant predictors of the magnitude of the effect. Future research should carefully address these factors and their influence on the potential therapeutic ability of CPAP treatment to improve cardiac outcomes and reduce the risks of adverse cardiac and noncardiac effects associated with untreated OSA.

關鍵字

Obstructive sleep apnea ； continuous positive airway pressure ； atrial fibrillation ； bradyarrhythmia ； ventricular arrhythmia