Abstract 9598: Continuous Positive Airway Pressure Therapy and Rate of Stroke in Patients With Atrial Fibrillation
Introduction: Obstructive sleep apnea (OSA) has been proven to be an independent risk factor for ischemic stroke (CVA) and may increase the risk of the latter in patients with atrial fibrillation (AF). Nasal continuous positive airway pressure (CPAP) is an effective treatment modality for OSA.
Hypothesis: CPAP compliance reduces rates of embolic strokes in patients with AF and comorbid OSA.
Methods: A retrospective study of patients referred to the Western Connecticut Health Network sleep laboratory between 2008 and 2011 was conducted to investigate the role of CPAP treatment on embolic CVA incidence in patients with AF and comorbid OSA. Patients with AF and no previous history of CVA were identified from medical records. The diagnosis of OSA was determined based on overnight polysomnography (PSG). Demographics, cardiovascular risk factors, results of PSG, and compliance with CPAP, where appropriate, were recorded. CPAP compliance was determined through outpatient chart review. Patients were deemed complaint if they used CPAP >4 hours/night or >70 % of the night according to monitoring chip information, confirmed at 3 consecutive follow ups with Pulmonologist. Univariate and multivariate analyses were conducted. Statistical significance was set at p<0.05.
Results: Of 5,138 patients screened for OSA between 2008 and 2011, 332 (6.4%) had AF. OSA was identified in 283 of these patients (85.6%). The occurrence of first time CVA within this group was 22.9%. We were able to determine the status of compliance with CPAP in 252 (89%) of patients. Patients who were not compliant with CPAP were more likely to have had a CVA than those who were complaint (18.5% vs. 10.3% p=0.004). After controlling for age, gender and coronary artery disease, the association between CPAP compliance and CVA remained statistically significant (adjusted odds ratio 1.75; 95% CI 1.162-2.6). Mean CHADS2 and CHA2DS2VASc scores were similar between the groups.
Conclusions: Adequate CPAP treatment of OSA in patients with AF likely reduces the risk of embolic CVA. Validation of this finding with prospective studies will be beneficial to further define the role of CPAP treatment in the prevention of CVA in this patient population.
Author Disclosures: D. Yaranov: None. A. Smyrlis: None. N. Usatii: None. A. Butler: None. J. Petrini: None. J. Mendez: None. M. Warshofsky: None.
- © 2014 by American Heart Association, Inc.