Obstructive Sleep Apnea as a Predictor of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis |
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| Affiliation: | 1. Department of Medicine, Queen''s University, Kingston, Ontario, Canada;2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;3. Department of Medicine, Western University, London, Ontario, Canada;4. Division of Cardiology, Kingston General Hospital, Queen''s University, Kingston, Ontario, Canada;1. Centre for Genetic Origins of Health and Disease, Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley;2. School of Anatomy, Physiology and Human Biology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley;3. School of Population Health, Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley;4. School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley;5. West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia;1. Electrophysiology Unit, Cardiology Department, Barcelona, Spain;2. Sleep Disorders Unit, Respiratory Medicine Department, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain;1. Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo;2. Hypertension Unit, University of São Paulo Medical School, São Paulo;3. Clinical Unit of Chronic Coronary Heart Disease, Heart Institute (InCor), University of São Paulo Medical School, São Paulo;4. Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo;5. Physicobiology Department, Federal University, São Paulo;6. Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Pernambuco, Brazil;1. Department of Cardiology, National University Heart Centre Singapore, Singapore;2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;3. Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore;4. Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore;5. Department of Mathematics and Statistics, La Trobe University, Australia;6. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore;1. Department of Medicine, Queen''s University, Kingston, Ontario, Canada;2. Department of Cardiac Surgery, Kingston General Hospital, Queen''s University, Kingston, Ontario, Canada;3. Department of Cardiology, Kingston General Hospital, Queen''s University, Kingston, Ontario, Canada;4. Department of Biomedical and Molecular Sciences, Queen''s University, Kingston, Ontario, Canada |
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| Abstract: | BackgroundPost–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.MethodsWe 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.ResultsFive 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).ConclusionsOSA was shown to be a strong predictor of PCAF. |
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