458 The effect of cardioversion therapy for atrial fibrillation on AHI in obstructive sleep apnea patients

Abstract

Abstract Introduction Sleep apnea (SA) is known to be associated with development of atrial fibrillation (AF), and therapy ameliorates this risk. Case reports and small series raise the possibility of a bidirectional effect of AF on SA burden. We hypothesize that SA control, demonstrated either by residual apnea-hypopnea index (AHI) or pressure during positive airway pressure (PAP) therapy, improves after successful cardioversion. Methods The cohort included VA patients with SA on PAP therapy who underwent successful outpatient direct-current AF cardioversion. Only patients with good adherence in the peri-procedural period, defined as use most days in the week before and after procedure, were included in the study (n=17). We compared AHI prior to and after cardioversion using the sign test since values were not normally distributed. Since most participants were on auto-titrating PAP, the sign test was also used to compare mean pressure difference in the 7 days before and after the procedure. Results There was no statistical difference when comparing AHI before and after AF cardioversion therapy (AHI change = -0.45, 95% CI = [-0.94, 0.17]) There was also no difference between mean pressure used for PAP therapy before and after therapy (pressure change = 0.05, 95% CI = [-0.1, 0.33]). Conclusion This small study did not find an association between successful AF cardioversion and PAP residual AHI or pressure (for auto-titrating machines). A larger cohort may have improved power to detect subtle effects of AF therapy on SA burden. Support (if any) This study was supported by the Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service.