Postoperative Atrial Fibrillation in Adults with Obstructive Sleep Apnea Undergoing Coronary Artery Bypass Grafting in the RICCADSA Cohort

Yüksel Peker, Henrik Holtstrand-Hjälm, Yeliz Celik, Helena Glantz, Erik Thunström, Yüksel Peker, Henrik Holtstrand-Hjälm, Yeliz Celik, Helena Glantz, Erik Thunström

Abstract

Postoperative atrial fibrillation (POAF) occurs in 20−50% of patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG). Obstructive sleep apnea (OSA) is also common in adults with CAD, and may contribute to POAF as well to the reoccurrence of AF in patients at long-term. In the current secondary analysis of the Randomized Intervention with Continuous Positive Airway Pressure (CPAP) in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), we included 147 patients with CABG, who underwent a home sleep apnea testing, in average 73 ± 30 days after the surgical intervention. POAF was defined as a new-onset AF occurring within the 30 days following the CABG. POAF was observed among 48 (32.7%) patients, occurring within the first week among 45 of those cases. The distribution of the apnea-hypopnea-index (AHI) categories < 5.0 events/h (no-OSA); 5.0−14.9 events/h (mild OSA); 15.0−29.9 events/h (moderate OSA); and ≥30 events/h (severe OSA), was 4.2%, 14.6%, 35.4%, and 45.8%, in the POAF group, and 16.2%, 17.2%, 39.4%, and 27.3%, respectively, in the no-POAF group. In a multivariate logistic regression model, there was a significant risk increase for POAF across the AHI categories, with the highest odds ratio (OR) for severe OSA (OR 6.82, 95% confidence interval 1.31−35.50; p = 0.023) vs. no-OSA, independent of age, sex, and body-mass-index. In the entire cohort, 90% were on β-blockers according to the clinical routines, they all had sinus rhythm on the electrocardiogram at baseline before the study start, and 28 out of 40 patients with moderate to severe OSA (70%) were allocated to CPAP. During a median follow-up period of 67 months, two patients (none with POAF) were hospitalized due to AF. To conclude, severe OSA was significantly associated with POAF in patients with CAD undergoing CABG. However, none of those individuals had an AF-reoccurrence at long term, and whether CPAP should be considered as an add-on treatment to β-blockers in secondary prevention models for OSA patients presenting POAF after CABG requires further studies in larger cohorts.

Trial registration: ClinicalTrials.gov NCT00519597.

Keywords: atrial fibrillation; coronary artery bypass grafting; coronary artery disease; obstructive sleep apnea.

Conflict of interest statement

Yüksel Peker received institutional grants from ResMed for the main RICCADSA trial. Henrik Holtstrand-Hjälm, Erik Thunström, Helena Glantz and Yeliz Celik report no conflict of interest.

Figures

Figure 1
Figure 1
Consort flow chart of the analytic study sample. Definition of abbreviations: AF = atrial fibrillation; CAD = coronary artery disease; CABG = coronary artery bypass grafting; CSA/CSR = Central Sleep Apnea/Cheyne-Stokes Respiration; PCI = percutaneous coronary intervention; POAF = Postoperative atrial fibrillation; RICCADSA = Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Obstructive Sleep Apnea.
Figure 2
Figure 2
Consort flow chart for the follow-up sample. Definition of abbreviations: AF = atrial fibrillation; AHI = apnea hypopnea index; CABG = coronary artery bypass grafting; POAF = Postoperative atrial fibrillation; RICCADSA = Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Obstructive Sleep Apnea.
Figure 3
Figure 3
Time frame of the occurrence of POAF in 48 cases following the surgery.
Figure 4
Figure 4
Proportion of occurrence of POAF across the AHI categories. Definition of abbreviations: AF = atrial fibrillation; AHI = apnea hypopnea index.

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