Abstract
BACKGROUND: While obstructive sleep apnea (OSA) is recognized as a risk factor for atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI), the preventive efficacy of continuous positive airway pressure (CPAP) remains conflicting across studies, necessitating further validation. METHODS: We conducted a meta-analysis integrating data from Web of Science, PubMed, and OVID databases to evaluate the association between OSA and AF recurrence post-PVI, as well as the effect of continuous positive airway pressure (CPAP). RESULTS: OSA patients demonstrated a significantly elevated risk of AF recurrence compared to controls (RR = 1.67, 95% CI:1.52-1.83). Stratified analyses revealed differential effects based on left atrial (LA) size: OSA patients without significant LA enlargement exhibited an risk ration (RR) of 2.13 (95% CI:1.63-2.79), and those with enlarged LA size showed an RR of 1.78 (95% CI:1.46-2.17). Subgroup stratification by AF type revealed no significant impact of OSA on recurrence in studies with paroxysmal AF only (RR = 1.15, 95% CI:0.74-1.77), whereas an elevated RR of 1.7 (95% CI:1.54-2.11) emerged in studies combining paroxysmal and persistent AF populations. CPAP therapy reduced AF recurrence risk overall (RR = 0.6, 95% CI:0.52-0.70), but this benefit varied by LA size comparability (no LA difference: RR = 0.58, 95% CI:0.33-1.01; significant LA difference: RR = 0.61, 95% CI:0.49-0.76). CPAP efficacy was evident in mixed AF populations (RR = 0.56, 95% CI:0.48-0.67) but absent in paroxysmal AF cohorts (RR = 1.3, 95% CI:0.71-1.50). CONCLUSION: This meta-analysis confirms that OSA is an independent predictor of AF recurrence following PVI. While CPAP therapy confers a general protective benefit, it does not have an effect in patients with paroxysmal AF or in those without left atrial enlargement. These results highlight the necessity of phenotypic stratification when designing and implementing CPAP-based preventive strategies.