Format

Send to

Choose Destination
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1250-1256. doi: 10.1053/j.jvca.2016.11.016. Epub 2016 Nov 14.

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

Author information

1
Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA. Electronic address: wongjk2003@gmail.com.
2
Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA.
3
Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA.
4
Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
5
Department of Psychiatry & Behavioral Science-Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA.

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.

KEYWORDS:

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

PMID:
28111105
DOI:
10.1053/j.jvca.2016.11.016
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center