Effekt av kontinuerlig positivt luftveistrykk på arytmi ved atrieflimmer og søvnapné

Søvnapné er svært utbredt hos pasienter med atrieflimmer, og begge tilstandene kan forverre kardiovaskulære sykdommer. Forskere fra Oslo universitetssykehus, St. Olavs hospital og Lovisenberg Diakonale Sykehus har i denne randomiserte kontrollerte studien undersøkt effekten av kontinuerlig positivt luftveistrykk (CPAP) på atrieflimmer hos pasienter med søvnapné . 109 pasienter med atrieflimmer og moderat til alvorlig søvnapné ble inkludert i studien hvor 55 pasienter ble behandlet med CPAP pluss standard behandling ved atrieflimmer, og 54 pasienter fikk standard behandling uten CPAP i 5 måneder. Resultatene viste at pasienter med atrieflimmer og søvnapné som fikk CPAP-behandling i tillegg til standard behandling ikke fikk en statistisk signifikant reduksjon i episodene med atrieflimmer.

Effect of Continuous Positive Airway Pressure on Arrhythmia in Atrial Fibrillation and Sleep Apnea: A Randomized Controlled Trial

Gunn Marit Traaen, Lars Aakerøy, Tove-Elizabeth Hunt, Britt Øverland, Christina Bendz, Lars Øivind Sande, Svend Akhus, Morten Wang Fagerland, Sigurd Steinshamn, Ole-Gunnar Anfinsen, Richard John Massey, Kaspar Broch, Thor Ueland, Harriet Akre, Jan Pål Loennechen, Lars Gullestad
 
Studien er publisert i American Journal of Respiratory and Critical Care Medicine

Rationale: Sleep apnea (SA) is highly prevalent in patients with atrial fibrillation (AF), and both conditions are associated with adverse cardiovascular outcomes.
Objectives: To determine the effect of continuous positive airway pressure (CPAP) on AF burden.
Methods: This open-label, parallel-group, randomized, controlled trial included patients with paroxysmal AF and moderate-to-severe SA (apnea-hypopnea index ≥15). Eligible patients were randomized (1:1) to 5 months' treatment with CPAP plus usual care (CPAP, n=55) or usual care alone (control, n=54) by a computerised system. Outcome assessment was blinded. The planned primary outcome was the difference between CPAP treatment and control in change of AF burden (% of time in AF), as measured by implantable loop recorder.
Measurements and main results: A total of 579 patients with paroxysmal AF had respiratory polygraphy, of whom 244 (42.1%) had moderate-to-severe SA. Of these, 158 (64.8%) participated in the CPAP run-in period, of whom 40 (25.3%) patients did not tolerate the treatment. One-hundred-eight patients were available for the primary analysis. The mean time in AF decreased from 5.6% at baseline to 4.1% during the last three months of CPAP intervention and from 5.0% to 4.3% in the control group. The adjusted between-group difference at follow-up was -0.63 (95% confidence interval: -2.55 to 1.30) percentage points; P=0.52. Seven serious adverse events (13%) occurred in the CPAP group, and two (4%) occurred in the control group.
Conclusions: In patients with paroxysmal AF and SA, treatment with CPAP did not result in a statistically significant reduction in the burden of AF.