Obstructive Sleep Apnea as a Predictor of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis

Abstract Background Post–coronary artery bypass grafting atrial fibrillation (PCAF) is associated with increased morbidity, mortality, and system costs. Few studies have explored obstructive sleep apnea (OSA) as a risk factor for PCAF. We aimed to systematically review and synthesize the evidence as...

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Bibliographic Details
Published in:Canadian journal of cardiology 2014-12, Vol.30 (12), p.1516-1522
Main Authors: Qaddoura, Amro, BHSc, Kabali, Conrad, PhD, Drew, Doran, BScH, van Oosten, Erik M., MD, MSc, Michael, Kevin A., MBChB, MPhil, Redfearn, Damian P., MBChB, Simpson, Christopher S., MD, Baranchuk, Adrian, MD
Format: Article
Language:English
Subjects:
Atrial Fibrillation - epidemiology
Atrial Fibrillation - etiology
Cardiovascular
Coronary Artery Bypass - adverse effects
Global Health
Humans
Incidence
Myocardial Ischemia - complications
Myocardial Ischemia - surgery
Postoperative Complications
Risk Factors
Sleep Apnea, Obstructive - complications
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Summary:Abstract Background Post–coronary artery bypass grafting atrial fibrillation (PCAF) is associated with increased morbidity, mortality, and system costs. Few studies have explored obstructive sleep apnea (OSA) as a risk factor for PCAF. We aimed to systematically review and synthesize the evidence associating OSA with PCAF. Methods We conducted a search of MEDLINE, EMBASE, Google Scholar, and Web of Science, as well as abstracts, conference proceedings, and reference lists until June 2014. Eligible studies were in English, were conducted in humans, and assessed OSA with polysomnography (PSG) or a validated questionnaire. Two reviewers independently selected studies, with disagreement resolved by consensus. Piloted forms were used to extract data and assess risk of bias. Results Five prospective cohort studies were included (n = 642). There was agreement in study selection (κ statistic, 0.89; 95% confidence interval [CI], 0.75-1.00). OSA was associated with a higher risk of PCAF (odds ratio [OR], 1.86; 95% CI 1.24-2.80; P  = 0.003; I2  = 35%). We conducted 3 subgroup analyses. The associations increased for data that used PSG to assess OSA (OR, 2.34; 95% CI, 1.48-3.70), when severe OSA was included from 1 study (OR, 2.59; 95% CI, 1.63-4.11), and when adjusted analyses were pooled (OR, 2.38; 95% CI, 1.57-3.62; P < 0.001 in all), with no heterogeneity detected in any subgroup analysis (I2 < 0.01% in all). Conclusions OSA was shown to be a strong predictor of PCAF.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2014.10.014