Long-term positive airway pressure therapy in patients with various forms of atrial fibrillation and obstructive sleep apnea

Aim. To study adherence to PAP therapy (positive airway pressure therapy) and it’s the long term (> 12 months) effectiveness and to investigate its possible effect on the course of atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA). Material and methods. The study included 39 patients with AF and OSA, who used PAP therapy for more than 12 months. Median age was 65 years, 90% were men. Prior to PAP therapy initiation 7 (18%) patients had moderate OSA, and 32 (82 %) had severe OSA. 29 (74%) patients had paroxysmal AF and 10 (26 %) — permanent AF. The course of AF was assessed by medical history, analysis of antiarrhythmic therapy, catheter ablation procedures, maintenance of the paroxysmal form of AF. The EHRA (European heart rhythm association) scale was used to assess the significance of the AF clinical manifestations. Аdherence and effectiveness of PAP therapy was examined by data downloaded from the device’s internal memory. The Epworth Sleepiness Scale was used to determine the level of daytime sleepiness. Results. Analysis showed that 26 (67%) of patients were adherent to PAP therapy (use > 70% nights, > 4 h/night), and 27 (69%) met the PAP therapy effectiveness criteria. PAP therapy lead to a persistent decrease in apnea-hypopnea index (AHI) from 40 events/ h to 3,4 events/h, p < 0,0001. PAP therapy led to significant decrease of daytime sleepiness severity. Recurrences of arrhythmias persisted in patients with paroxysmal AF and its transformation into a permanent form was observed in 17,6% of patients. Tolerance of AF according to the EHRA scale improved by 80,7% in adherent to PAP therapy patients. Conclusion. PAP therapy has long-term effectiveness in the reduction of sleep respiratory disorders. Recurrence of AF and its transition to a permanent form was still possible on PAP therapy and antiarrhythmic treatment.