Sleep-disordered breathing associated with an increased risk of postoperative atrial fibrillation

A meta-analysis found that postoperative atrial fibrillation was associated with respiratory sleep disturbances in patients undergoing heart surgery.

According to a new review published in Annals of Medicine.

POAF is a clinical complication of cardiac surgery, with an estimated incidence of 35%. The possible 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 search articles published before August 2022. data on the relationship between SDB and POAF in patients who underwent 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 using 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 without SDB. These studies were published in 11 countries between 1996 and 2022; 8 studies were from the United States, 5 from China, 2 each from Sweden and Iran, and 1 each from Brazil, Canada, France, Japan, Turkey, Singapore, and Italy.

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

A 45% greater risk of POAF was found in the SDB group in patients who had undergone elective heart surgery (odds ratio, 1.49; 95% CI, 1.30-1.70). A subgroup analysis performed using SDB measurement method, SDB type, study design and surgery type – excluding patients with a prior history of atrial fibrillation – found that SDB defined by medical devices, studies with a prospective study design, history of CABG, and excluding a history of atrial fibrillation might increase the association between SDB and POAG.

There were some limitations to the meta-analysis. Only 24 studies were included, which may not have been enough to obtain definitive results; exclusion of unpublished data may have biased the results; patients were admitted after their SDB was diagnosed based on scores and data from medical records; and retrospective studies were included, so future studies 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 undergoing cardiac surgery.

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


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

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