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Continuous Positive Airway Pressure Reduces Nocturnal Arrhythmia Avalanche Burden in Obstructive Sleep Apnea: An Adherence-Dependent Effect

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dc.contributor.authorShahrbabaki, S.S.
dc.contributor.authorMittinty, M.
dc.contributor.authorTonchev, I.R.
dc.contributor.authorStrong, C.
dc.contributor.authorChapman, D.
dc.contributor.authorLorensini, S.
dc.contributor.authorJenkins, E.
dc.contributor.authorCatcheside, P.
dc.contributor.authorAdams, R.
dc.contributor.authorEckert, D.J.
dc.contributor.authorSanders, P.
dc.contributor.authorGanesan, A.N.
dc.date.issued2025
dc.descriptionOnlinePubl
dc.description.abstractBackground Continuous positive airway pressure (CPAP) is the primary treatment for obstructive sleep apnea (OSA), but randomized evidence for arrhythmia reduction is lacking. Nocturnal arrhythmia avalanches (NAAs)—frequent, nonsustained arrhythmic episodes associated with cardiovascular mortality—may provide enhanced statistical power for detecting treatment effects. Objective This study aimed to determine whether CPAP therapy reduces NAA burden in patients with OSA and whether this effect is dependent on treatment adherence. Methods We conducted a secondary analysis of electrocardiographic data from the Heart Biomarker Evaluation in Apnea Treatment randomized trial. Participants with OSA (apnea-hypopnea index 15–50 events/h) were randomized to sleep hygiene education (control), CPAP plus education, or nocturnal supplemental oxygen plus education. NAAs were defined as ≥30% drops in R-R intervals followed by a return to 90% of baseline. The primary end point was the change in NAA burden; secondary end points included adherence effects and risk factor interactions. Results Among 245 participants with complete electrocardiographic data, baseline NAA characteristics were well balanced across groups (all P > .49). CPAP reduced NAA burden by 260 episodes (40% reduction; 95% confidence interval −510.5 to −9.5; P = .024), whereas control and nocturnal supplemental oxygen groups showed no significant change. Each additional day of effective CPAP use (≥4 h/night) was associated with 88.8 fewer NAAs (95% confidence interval −149.2 to −28.5; P = .004), a 14% reduction/adherent-night. Both high body mass index (P = .009) and smoking (P = .015) reduced CPAP therapy effectiveness. Conclusion CPAP therapy produces an adherence-dependent reduction in nocturnal arrhythmic burden in patients with OSA. This represents CPAP’s positive effects on nocturnal nonsustained arrhythmic episodes, with efficacy modulated by body mass index and smoking status.
dc.description.statementofresponsibilitySobhan Salari Shahrbabaki, Murthy Mittinty, Ivaylo R. Tonchev, Campbell Strong, Darius Chapman, Scott Lorensini, Evan Jenkins, Peter Catcheside, Robert Adams, Danny J. Eckert, Prashanthan Sanders, Anand N. Ganesan
dc.identifier.citationHeart Rhythm, 2025; 23(4):1-10
dc.identifier.doi10.1016/j.hrthm.2025.12.015
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidMittinty, M. [0000-0001-8778-9793]
dc.identifier.orcidAdams, R. [0000-0002-7572-0796]
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/149427
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT2010522
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2016029
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1196261
dc.rights© 2025 Heart Rhythm Society. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
dc.source.urihttps://doi.org/10.1016/j.hrthm.2025.12.015
dc.subjectobstructive sleep apnea; continuous positive airway pressure; nocturnal arrhythmia avalanches; atrial fibrillation; Heart rhythm; adherence; Cardiovascular risk; sleep-disordered breathing; obesity; randomized controlled trial
dc.titleContinuous Positive Airway Pressure Reduces Nocturnal Arrhythmia Avalanche Burden in Obstructive Sleep Apnea: An Adherence-Dependent Effect
dc.typeJournal article
pubs.publication-statusPublished online

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