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Correspondence |

CPAP in Obstructive Sleep Apnea and Atrial Flutter-FibrillationObstructive Sleep Apnea and Atrial Flutter: Is This Truly Two for the Price of One? FREE TO VIEW

Antonio M. Esquinas, MD, PhD, FCCP; Egbert Pravinkumar, MD
Author and Funding Information

From the Intensive Care Unit (Dr Esquinas), Hospital General Universitario Morales Meseguer; and Department of Critical Care (Dr Pravinkumar), Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center.

Correspondence to: Antonio M. Esquinas, MD, PhD, FCCP, Intensive Care Unit, Hospital General Universitario Morales Meseguer, Av Marques de los Velez, s/n, Murcia 30008, Spain; e-mail: antmesquinas@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):713. doi:10.1378/chest.13-0621
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To the Editor:

There is growing research interest in the association between atrial fibrillation (AF) and obstructive sleep apnea (OSA), which are independently common diseases that have a serious impact on health, quality of life, and health-care resources.1 In many cases, both these diseases show a parallelism in that appropriate early diagnosis and treatment have demonstrated positive clinical benefits.1

However, studies are promoting positive interactions of CPAP for preventing and reducing recurrences of AF, despite the lack of clear evidence-based analysis and guidelines. We read with interest the article by Bazan et al2 in CHEST (May 2013) in this area of growing interest. We would like to comment on some aspects of their study that are relevant to clinical practice.

First, there are some functional and structural cardiac changes that were not evaluated in this study and could potentially influence the results. The relationship between the duration of CPAP use and echocardiographic findings were not discussed but can provide a better understanding of whether CPAP could influence AF and recurrences. Additionally, echocardiographic factors such as left atrial diameter variations, severity of mitral valve regurgitation, and left ventricular hypertrophy were not measured,3 but these are potentially strong predictive factors for AF and recurrences.

Second, the authors did not describe correlations between OSA, efficacy of antiarrhythmic drugs, and CPAP therapy and AF recurrence.4 Third, there were no data on CPAP compliance and duration of CPAP use among patients who had and did not have AF recurrences following ablation therapy for atrial flutter. Fourth, the authors presented no data on other causal factors for AF. In one study, OSA was a strong predictor of recurrent AF after an ablation procedure; BMI, ejection fraction, left atrial size, and hypertension did not affect the outcomes postablation for atrial flutter.5 Finally, other relevant measurements such as levels of N-terminal pro-B-type natriuretic peptide or B-type natriuretic peptide were not provided.

We believe that the study by Bazan et al2 provides valuable information with regard to OSA and AF recurrences, but mechanisms that influence this association remain complex. Further studies that look at cardiac structural and functional modifications to identify triggers or promoters of atrial flutter recurrences are necessary.

References

Digby GC, Baranchuk A. Sleep apnea and atrial fibrillation; 2012 update. Curr Cardiol Rev. 2012;8(4):265-272. [CrossRef]
 
Bazan V, Grau N, Valles Eet al. Obstructive sleep apnea in patients with typical atrial flutter: prevalence and impact on arrhythmia control outcome. Chest. 2013;143(5):1277-1283. [CrossRef]
 
Da Costa A, Romeyer C, Mourot S, et al. Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study. Eur Heart J. 2002;23(6):498-506. [CrossRef]
 
Monahan K, Brewster J, Wang L, et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol. 2012;110(3):369-372. [CrossRef]
 
Jongnarangsin K, Chugh A, Good E, et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19(7):668-672. [CrossRef]
 

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References

Digby GC, Baranchuk A. Sleep apnea and atrial fibrillation; 2012 update. Curr Cardiol Rev. 2012;8(4):265-272. [CrossRef]
 
Bazan V, Grau N, Valles Eet al. Obstructive sleep apnea in patients with typical atrial flutter: prevalence and impact on arrhythmia control outcome. Chest. 2013;143(5):1277-1283. [CrossRef]
 
Da Costa A, Romeyer C, Mourot S, et al. Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study. Eur Heart J. 2002;23(6):498-506. [CrossRef]
 
Monahan K, Brewster J, Wang L, et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol. 2012;110(3):369-372. [CrossRef]
 
Jongnarangsin K, Chugh A, Good E, et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19(7):668-672. [CrossRef]
 
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