Effect of continuous positive airway pressure on non-fatal stroke and paroxysmal atrial fibrillation recurrence in obstructive sleep apnoea elderly patients

Background: Obstructive sleep apnoea (OSA) is the most common and clinically significant sleep breathing disorder, with a high prevalence in elderly with cardiovascular diseases . OSA is often under-recognised and under-treated in clinical practice. The aim of this study is to investigate possible differences in major cardiovascular events (MACE) incidence and Paroxysmal Atrial Fibrillation (PAF) recurrence between patients receiving Continuous positive airway pressure (CPAP) treatment versus no CPAP treatment, in a cohort of elderly OSA patients with several comorbidities and history of PAF. Methods: In this prospective observational study we enrolled 420 patients aged ≥65 years, suffering from PAF, with a first diagnosis of moderate/severe OSA and indication for CPAP-mode ventilotherapy. Patients underwent clinical-instrumental and laboratory evaluation for a mean follow-up of 22.0 months. Results: CPAP treatment added on usual pharmacological care was associated with a reduced risk of MACE (HR 0.31, p < 0.001) and recurrence of PAF (HR 0.33, p < 0.001). Conclusion: This study supports the role of moderate/severe OSA as a risk factor for MACE and recurrent AF. CPAP treatment with optimal compliance and good tolerability, combined with usual medical care for cardiometabolic comorbidities, is associated with a lower incidence of MACE and recurrent PAF in elderly with several comorbidities.