Impact of obstructive sleep apnea hypopnea syndrome on risk of atrial fibrillation with coronary artery disease: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

MAO Ting ^1,2 ,  ZHANG Jingchun ^1,2 ,  LIU Yue ^1,2 , QIAO Yu ^1,2 , SUN Xinli ^1,2 , LIU Bei ^1,2

1. Cardiovascular Diseases Center of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;
2. Institute of Cardiovascular Diseases, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;

Corresponding author：

ZHANG Jingchun, Email: zhangjingchun276@vip.sohu.com; LIU Yue, Email: liuyue@188.com

Keywords：

Obstructive sleep apnea hypopnea syndrome; Atrial fibrillation; Coronary artery disease; Cohort study; Meta-analysis

DOI：

10.7507/1672-2531.201808008

Video：

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Objective To systematically review whether or not obstructive sleep apnea hypopnea syndrome (OSAHS) increases the incidence of atrial fibrillation in coronary artery disease patients.Methods PubMed, EMbase, The Cochrane Library, SinoMed, CNKI, VIP and WanFang Data databases were searched for studies on the relationship between OSAHS and the incidence of atrial fibrillation in coronary artery disease patients from inception to July 2^nd, 2018. Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.Results In total, 11 cohort studies were included, involving 709 in exposed group and 975 in non-exposed group. The results of meta-analysis indicated that OSAHS was associated with the incidence of atrial fibrillation in coronary artery disease patients (RR=2.01, 95%CI 1.72 to 2.36, P<0.000 01). The subgroup analysis showed that OSAHS of PSG diagnosis increased the risk of the incidence of atrial fibrillation in coronary artery disease patients (RR=2.40, 95%CI 1.84 to 3.12, P<0.000 01); moderate and severe OSAHS of PSG diagnosis had higher risk of the incidence of atrial fibrillation in coronary artery disease patients (RR=3.73, 95%CI 2.51 to 5.53, P<0.000 01); high risk OSAHS of Berlin questionnaire assessment increased the incidence of atrial fibrillation in CAD patients (RR=1.56, 95%CI 1.27 to 1.92, P<0.000 1).Conclusion The current evidence indicates that OSAHS is associated with an increased risk of atrial fibrillation in coronary artery disease patients. Due to the limitation of quality and quantity of the included studies, more large-scale and fine quality research are needed to warrant the accuracy of conclusion above.

Citation： MAO Ting, ZHANG Jingchun, LIU Yue, QIAO Yu, SUN Xinli, LIU Bei. Impact of obstructive sleep apnea hypopnea syndrome on risk of atrial fibrillation with coronary artery disease: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(4): 404-411. doi: 10.7507/1672-2531.201808008 Copy

1.	Pietzsch JB, Garner A, Cipriano LE, et al. An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep, 2011, 34(6): 695-709.
2.	Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet, 2009, 373(9657): 82-93.
3.	Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc, 2008, 5(2): 136-143.
4.	Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol, 2007, 49(5): 565-571.
5.	Monahan K, Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol, 2011, 26(6): 541-547.
6.	Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA, 2004, 292(20): 2471-2477.
7.	Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol, 2014, 11(11): 639-654.
8.	Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace, 2006, 8(9): 651-745.
9.	Jongnarangsin K, Chugh A, Good E, et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol, 2008, 19(7): 668-672.
10.	Chilukuri K, Dalal D, Marine JE, et al. Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace, 2009, 11(7): 896-901.
11.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
12.	Amra B, Niknam N, Sadeghi MMM, et al. Obstructive sleep apnea and postoperative complications in patients undergoing coronary artery bypass graft surgery: a need for preventive strategies. Intern J Prev Med, 2014, 5(11): 1446-1451.
13.	Grilli F, Pasquino S, Gallinella E, et al. Obstructive sleep apnea (OSA) and cardiovascular risk in patients undergoing CABG (coronary artery by-pass grafting). Rivista Italiana di Neurobiologia, 2007, 4(3-4): 197-202.
14.	李虹, 杜以明. 冠心病合并 OSAHS 患者夜间心律失常情况分析. 山东医药, 2009, 49(51): 52-53.
15.	Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis, 1996, 7(6): 475-478.
16.	Mungan U, Ozeke O, Mavioglu L, et al. The role of the preoperative screening of sleep apnoea by Berlin Questionnaire and Epworth Sleepiness Scale for postoperative atrial fibrillation. Heart Lung Circ, 2013, 22(1): 38-42.
17.	倪良春, 仇杰, 刘高利, 等. OSAHS 严重程度与 CABG 后新发心房颤动关联研究. 中国循证心血管医学杂志, 2017, 9(6): 693-695.
18.	Patel SV, Gill H, Shahi D, et al. High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis. Sleep Breath, 2018, 22(4): 1117-1124.
19.	Uchoa CHG, Danzi-Soares NJ, Nunes FS, et al. Impact of OSA on cardiovascular events after coronary artery bypass surgery. Chest, 2015, 147(5): 1352-1360.
20.	van Oosten EM, Hamilton A, Petsikas D, et al. Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol, 2014, 113(6): 919-923.
21.	Wong JK, Maxwell BG, Kushida CA, et al. Obstructive sleep apnea is an independent predictor of postoperative atrial fibrillation in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5): 1140-1147.
22.	Zhao LP, Kofidis T, Lim TW, et al. Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting. J Crit Care, 2015, 30(6): 1418.
23.	Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med, 1999, 131(7): 485-491.
24.	Yumino D, Wang H, Floras JS, et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail, 2009, 15(4): 279-285.
25.	Gami AS, Pressman G, Caples SM. Association of atrial fibrillation and obstructive sleep apnea. Acc Curr J Rev, 2004, 110(4): 364.
26.	van Wagoner DR, Piccini JP, Albert CM, et al. Progress toward the prevention and treatment of atrial fibrillation: a summary of the heart rhythm society research forum on the treatment and prevention of atrial fibrillation, Washington, DC, December 9-10, 2013. Heart Rhythm, 2015, 12(1): e5-e29.
27.	Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation, 2014, 129(8): 837-847.
28.	Tanigawa T, Yamagishi K, Sakurai S, et al. Arterial oxygen desaturation during sleep and atrial fibrillation. Heart, 2006, 92(12): 1854-1855.
29.	Cadby G, McArdle N, Briffa T, et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest, 2015, 148(4): 945-952.
30.	Unosawa S, Sezai A, Akahoshi T, et al. Arrhythmia and sleep-disordered breathing in patients undergoing cardiac surgery. J Cardiol, 2012, 60(1): 61-65.
31.	Kaw R, El Zarif S, Wang L, et al. Obesity as an effect modifier in sleep-disordered breathing and postcardiac surgery atrial fibrillation. Chest, 2017, 151(6): 1279-1287.
32.	Linz D, Linz B, Hohl M, et al. Atrial arrhythmogenesis in obstructive sleep apnea: therapeutic implications. Sleep Med Rev, 2016, 26: 87-94.
33.	Linz D, Schotten U, Neuberger HR, et al. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm, 2011, 8(9): 1436-1443.
34.	Channaveerappa D, Lux JC, Wormwood KL, et al. Atrial electrophysiological and molecular remodelling induced by obstructive sleep apnoea. J Cell Mol Med, 2017, 21(9): 2223-2235.
35.	Drager LF, Bortolotto LA, Pedrosa RP, et al. Left atrial diameter is independently associated with arterial stiffness in patients with obstructive sleep apnea: potential implications for atrial fibrillation. Int J Cardiol, 2010, 144(2): 257-259.
36.	Drager LF, Bortolotto LA, Pedrosa RP, et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest, 2007, 131(5): 1379-1386.
37.	Sahadevan J, Srinivasan D. Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. Curr Treat Options Cardiovasc Med, 2012, 14(5): 520-528.
38.	Linz D, Mahfoud F, Linz B, et al. Effect of obstructive respiratory events on blood pressure and renal perfusion in a pig model for sleep apnea. Am J Hypertens, 2014, 27(10): 1293-1300.
39.	Schulz R, Schmidt D, Blum A, et al. Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea: response to CPAP therapy. Thorax, 2000, 55(12): 1046-1051.
40.	Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med, 2000, 162(2 Pt 1): 566-570.
41.	Del Ben M, Fabiani M, Loffredo L, et al. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment. BMC Pulm Med, 2012, 12: 36.
42.	Schwarz EI, Puhan MA, Schlatzer C, et al. Effect of CPAP therapy on endothelial function in obstructive sleep apnoea: a systematic review and meta-analysis. Respirology, 2015, 20(6): 889-895.

1. Pietzsch JB, Garner A, Cipriano LE, et al. An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep, 2011, 34(6): 695-709.
2. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet, 2009, 373(9657): 82-93.
3. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc, 2008, 5(2): 136-143.
4. Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol, 2007, 49(5): 565-571.
5. Monahan K, Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol, 2011, 26(6): 541-547.
6. Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA, 2004, 292(20): 2471-2477.
7. Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol, 2014, 11(11): 639-654.
8. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace, 2006, 8(9): 651-745.
9. Jongnarangsin K, Chugh A, Good E, et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol, 2008, 19(7): 668-672.
10. Chilukuri K, Dalal D, Marine JE, et al. Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace, 2009, 11(7): 896-901.
11. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
12. Amra B, Niknam N, Sadeghi MMM, et al. Obstructive sleep apnea and postoperative complications in patients undergoing coronary artery bypass graft surgery: a need for preventive strategies. Intern J Prev Med, 2014, 5(11): 1446-1451.
13. Grilli F, Pasquino S, Gallinella E, et al. Obstructive sleep apnea (OSA) and cardiovascular risk in patients undergoing CABG (coronary artery by-pass grafting). Rivista Italiana di Neurobiologia, 2007, 4(3-4): 197-202.
14. 李虹, 杜以明. 冠心病合并 OSAHS 患者夜间心律失常情况分析. 山东医药, 2009, 49(51): 52-53.
15. Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis, 1996, 7(6): 475-478.
16. Mungan U, Ozeke O, Mavioglu L, et al. The role of the preoperative screening of sleep apnoea by Berlin Questionnaire and Epworth Sleepiness Scale for postoperative atrial fibrillation. Heart Lung Circ, 2013, 22(1): 38-42.
17. 倪良春, 仇杰, 刘高利, 等. OSAHS 严重程度与 CABG 后新发心房颤动关联研究. 中国循证心血管医学杂志, 2017, 9(6): 693-695.
18. Patel SV, Gill H, Shahi D, et al. High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis. Sleep Breath, 2018, 22(4): 1117-1124.
19. Uchoa CHG, Danzi-Soares NJ, Nunes FS, et al. Impact of OSA on cardiovascular events after coronary artery bypass surgery. Chest, 2015, 147(5): 1352-1360.
20. van Oosten EM, Hamilton A, Petsikas D, et al. Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol, 2014, 113(6): 919-923.
21. Wong JK, Maxwell BG, Kushida CA, et al. Obstructive sleep apnea is an independent predictor of postoperative atrial fibrillation in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5): 1140-1147.
22. Zhao LP, Kofidis T, Lim TW, et al. Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting. J Crit Care, 2015, 30(6): 1418.
23. Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med, 1999, 131(7): 485-491.
24. Yumino D, Wang H, Floras JS, et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail, 2009, 15(4): 279-285.
25. Gami AS, Pressman G, Caples SM. Association of atrial fibrillation and obstructive sleep apnea. Acc Curr J Rev, 2004, 110(4): 364.
26. van Wagoner DR, Piccini JP, Albert CM, et al. Progress toward the prevention and treatment of atrial fibrillation: a summary of the heart rhythm society research forum on the treatment and prevention of atrial fibrillation, Washington, DC, December 9-10, 2013. Heart Rhythm, 2015, 12(1): e5-e29.
27. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation, 2014, 129(8): 837-847.
28. Tanigawa T, Yamagishi K, Sakurai S, et al. Arterial oxygen desaturation during sleep and atrial fibrillation. Heart, 2006, 92(12): 1854-1855.
29. Cadby G, McArdle N, Briffa T, et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest, 2015, 148(4): 945-952.
30. Unosawa S, Sezai A, Akahoshi T, et al. Arrhythmia and sleep-disordered breathing in patients undergoing cardiac surgery. J Cardiol, 2012, 60(1): 61-65.
31. Kaw R, El Zarif S, Wang L, et al. Obesity as an effect modifier in sleep-disordered breathing and postcardiac surgery atrial fibrillation. Chest, 2017, 151(6): 1279-1287.
32. Linz D, Linz B, Hohl M, et al. Atrial arrhythmogenesis in obstructive sleep apnea: therapeutic implications. Sleep Med Rev, 2016, 26: 87-94.
33. Linz D, Schotten U, Neuberger HR, et al. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm, 2011, 8(9): 1436-1443.
34. Channaveerappa D, Lux JC, Wormwood KL, et al. Atrial electrophysiological and molecular remodelling induced by obstructive sleep apnoea. J Cell Mol Med, 2017, 21(9): 2223-2235.
35. Drager LF, Bortolotto LA, Pedrosa RP, et al. Left atrial diameter is independently associated with arterial stiffness in patients with obstructive sleep apnea: potential implications for atrial fibrillation. Int J Cardiol, 2010, 144(2): 257-259.
36. Drager LF, Bortolotto LA, Pedrosa RP, et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest, 2007, 131(5): 1379-1386.
37. Sahadevan J, Srinivasan D. Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. Curr Treat Options Cardiovasc Med, 2012, 14(5): 520-528.
38. Linz D, Mahfoud F, Linz B, et al. Effect of obstructive respiratory events on blood pressure and renal perfusion in a pig model for sleep apnea. Am J Hypertens, 2014, 27(10): 1293-1300.
39. Schulz R, Schmidt D, Blum A, et al. Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea: response to CPAP therapy. Thorax, 2000, 55(12): 1046-1051.
40. Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med, 2000, 162(2 Pt 1): 566-570.
41. Del Ben M, Fabiani M, Loffredo L, et al. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment. BMC Pulm Med, 2012, 12: 36.
42. Schwarz EI, Puhan MA, Schlatzer C, et al. Effect of CPAP therapy on endothelial function in obstructive sleep apnoea: a systematic review and meta-analysis. Respirology, 2015, 20(6): 889-895.

Chinese Journal of Evidence-Based Medicine

Impact of obstructive sleep apnea hypopnea syndrome on risk of atrial fibrillation with coronary artery disease: a systematic review

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