Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Zhenni Chen; Rui Zhang; Xueru Hu; Chun Wan; Yongchun Shen; Jiangyue Qin; Lijuan Gao; Jing Zhu

doi:10.1080/07853890.2022.2143555

Impact of sleep disordered breathing on postoperative atrial fibrillation in patients who underwent cardiac surgery: a meta-analysis

Ann Med. 2022 Dec;54(1):3177-3188. doi: 10.1080/07853890.2022.2143555.

Authors

Zhenni Chen¹, Rui Zhang², Xueru Hu³, Chun Wan³, Yongchun Shen³, Jiangyue Qin³, Lijuan Gao³, Jing Zhu³

Affiliations

¹ West China School of Medicine/West China Hospital of Sichuan University and West China Tianfu Hospital of Sichuan University, Chengdu, China.
² Information Center, West China Hospital of Sichuan University, Chengdu, China.
³ Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

Abstract

Objective: An increasing number of studies suggest that sleep disordered breathing (SDB) may be associated with postoperative atrial fibrillation (POAF), but these studies present discrepant results. Thus, this meta-analysis aimed to synthesize the data associating SDB with POAF in patients who underwent cardiac surgery.Methods: A literature search was performed in the Scopus, PubMed, Web of Science, EMBASE, CENTRAL, Weipu, Wanfang Data, and China National Knowledge Infrastructure databases before August 2022. Data were extracted, and the strength of the relationship between SDB and the risk of POAF was evaluated using odds ratio (OR) and 95% confidence intervals (CIs). All statistical analysis was carried out using the Stata 12.0 software.Results: A total of 24 studies with 660,685 subjects were included in current meta-analysis. SDB was significantly associated with the risk of POAF in the patients who underwent cardiac surgery (OR = 1.49; 95% CI, 1.30-1.70; p < .001). Next subgroup analysis revealed that such association may be increased in the group with medical equipment-measured SDB (OR = 2.27; 95% CI, 1.59-3.23; p < .001), prospective studies (OR = 2.17; 95% CI, 1.55-3.03; p < .001), patients without a previous history of atrial fibrillation (OR = 2.04; 95% CI, 1.47-2.82; p < .001), and patients who received a coronary artery bypass graft (OR = 2.10; 95% CI, 1.45-3.05; p < .001). No publication bias was identified.Conclusion: The results of meta-analysis support that SDB may be associated with an increased risk of POAF in patients who had undergone cardiac surgery, and these results should be confirmed in more rigorously designed studies.KEY MESSAGESPatients with SDB who underwent cardiac surgery showed increased risk of POAF.The relationship between SDB and POAF should be explained with caution with the consideration of various covariate.The effect of pre-treatment of SDB on POAF should be examined in future.

Keywords: Sleep disordered breathing; cardiac surgery; meta-analysis; postoperative atrial fibrillation.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / epidemiology
Atrial Fibrillation* / etiology
Cardiac Surgical Procedures* / adverse effects
Humans
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Prospective Studies
Risk Factors
Sleep Apnea Syndromes* / complications
Sleep Apnea Syndromes* / epidemiology

Grants and funding

This work was supported by grants from the 1•3•5 Project for Disciplines of Excellence, West China Hospital, Sichuan University [2019HXFH042] and National Natural Science Foundation of China [31871157]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.