Sleep-Disordered Breathing Associated With Increased Risk of Postoperative Atrial Fibrillation

Patients who underwent cardiac surgery were at an increased risk of having postoperative atrial fibrillation (POAF) if they had sleep-disordered breathing (SDB), according to a new review published in Annals of Medicine.

POAF is a clinical complication in cardiac surgery, with an approximate incidence rate of 35%. The potential relationship between SDB and POAF has been evaluated in several studies, especially the relationship between POAF and obstructive sleep apnea, and the current review aimed to find the association between SDB and POAF using available publications.

The researchers used Scopus, PubMed, Web of Science, EMBASE, Cochrane Central Registry for Controlled Trials, Wanfang Data, Weipu databases, and China National Knowledge Infrastructure to do a literature search of articles published prior to August 2022. Studies were included if they presented data on the relationship between SDB and POAF on patients who had cardiac surgery, evaluated SDB status before cardiac surgery, and recorded POAF during the postoperative hospital stay or follow-up. All studies were assessed for bias risk with the Newcastle-Ottawa Scale.

Twenty-four studies were included in the meta-analysis, and they accounted for 45,361 participants with SDB and 615,324 participants who did not have SDB. These studies were published between 1996 and 2022 in 11 countries; 8 studies came from the United States, 5 from China, 2 each from Sweden and Iran, and 1 each in Brazil, Canada, France, Japan, Turkey, Singapore, and Italy.

The incidence of POAF in patients with SDB ranged from 8% to 67% compared 6% to 42% in patients without SDB. Atrial fibrillation was diagnosed via continuous electrocardiographic monitoring and electrocardiographic examinations, and the most common surgery type was coronary artery bypass graft (CABG).

A 45% greater risk of POAF was found in the SDB group in patients who had elective cardiac surgery (odds ratio, 1.49; 95% CI, 1.30-1.70). A subgroup analysis that was conducted by using the SDB measurement method, SDB type, study design, and surgery type—that excluded patients with a former history of atrial fibrillation—found that SDB defined by medical equipment, studies with a prospective study design, history of CABG, and excluding a previous history of atrial fibrillation could increase the association between SDB and POAG.

There were some limitations to the meta-analysis. There were only 24 studies included, which may not have been enough to obtain conclusive results; exclusion of unpublished data may have biased the results; patients were included following their SDB being diagnosed based on scores and data from medical records; and retrospective studies were included, so future investigations and reviews should have stricter inclusion criteria.

The researchers concluded that the meta-analysis found a significant association between SDB and the risk of POAF in patients who had cardiac surgery.

“However, more studies should be conducted to validate our results and establish a comprehensive management for patients with SBD,” the authors concluded.

Reference

Chen Z, Zhang R, Hu X, et al. Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis. Ann Med. Published online November 9, 2022. doi:10.1080/07853890.2022.2143555