Atrial Fibrillation Recurrence in Sleep Apnea

sleep apnea is a common disorder which is increasingly implicated in the pathogenesis of
cardiovascular disease. Observational data suggest that sleep apnea may play a role in the
development of atrial fibrillation (AF), and may even predispose to recurrence of AF
following electrical cardioversion (DCCV). Because of biases and confounders inherent to
observational studies, we propose a randomized clinical trial to assess the effects of
treatment of sleep apnea in subjects with AF treated with DCCV. Following polysomnography,
subjects with sleep apnea will be randomized to positive airway pressure (PAP) or usual
medical care and followed for up to one year to compare a primary outcome of AF recurrence
rate.

Inclusion criteria:

1. Age >18 yrs

2. Successful electrical or chemical cardioversion within previous 2 weeks

3. Greater than 2 episodes symptomatic AF in previous 6 months

Exclusion criteria:

1. Currently on PAP therapy

2. Moderate to severe pulmonary disease

3. Neurologic impairment (h/o CVA, TIA, neuromuscular disease, diaphragmatic paralysis)

4. Severe cardiac disease (LVEF<40%, greater than mild to moderate valvular disease)

5. Post cardiac surgery AF

6. Congenital heart disease

7. Renal disease (Scr > 2.5)

8. Excessive EtOH use (>2 drinks/day)

9. Anatomically fixed nasal obstruction (severe septal deviation, uncontrolled rhinitis)

10. History of motor vehicle or occupational accident related to sleepiness.

11. Epworth Sleepiness Scale score >18 (out of maximum score of 24).