• Jim K Wong, Edward R Mariano, Anthony G Doufas, Megan J Olejniczak, and Clete A Kushida.
• Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA. Electronic address: wongjk2003@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2017 Aug 1; 31 (4): 1250-1256.

ObjectiveBased on clinical studies in the nonsurgical population that positive airway pressure (PAP) therapy for patients with obstructive sleep apnea (OSA) provides benefits for those with atrial fibrillation, the authors tested the hypothesis that PAP in patients with OSA reduces the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery.DesignRetrospective analysis.SettingSingle-center university hospital.ParticipantsThe study comprised 192 patients in sinus rhythm preoperatively who were undergoing nontransplantation or ventricular assist device implantation cardiac surgery requiring cardiopulmonary bypass but not requiring systemic circulatory arrest, with documented PAP adherence from January 2008 to October 2015.InterventionsRetrospective review of medical records.Measurements And Main ResultsPOAF was defined as atrial fibrillation requiring therapeutic intervention. Of the 192 patients with OSA, 104 (54%) were documented to be PAP-adherent and 88 (46%) were reported to be PAP-nonadherent. Among PAP users, 49 (47%) developed POAF; among PAP nonusers, 59 (66%) developed POAF. The adjusted hazard ratio was 0.59 (95% confidence interval 0.40-0.86, p<0.01). No differences were observed in intensive care unit length of stay (4.0±3.4 days for PAP-adherent group v 5.0±6.2 days for PAP-nonadherent group; p = 0.22) or hospital length of stay (10.7±6.6 days for PAP-adherent group v 10.9±7.3 days for PAP nonadherent group; p = 0.56). A lower median postoperative creatinine rise was observed in PAP-adherent patients (18.2% [8.3%-37.5%) v 31.3% [13.3%-50%]; p< 0.01).ConclusionPreoperative PAP use in patients with OSA was associated with a decreased rate of POAF after cardiac surgery.Published by Elsevier Inc.

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