ECG risk markers for atrial fibrillation and sudden cardiac death in minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised trial

Christian Schlatzer; Daniel J Bratton; Sonja E Craig; Malcolm Kohler; John R Stradling

doi:10.1136/bmjopen-2015-010150

ECG risk markers for atrial fibrillation and sudden cardiac death in minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised trial

BMJ Open. 2016 Mar 16;6(3):e010150. doi: 10.1136/bmjopen-2015-010150.

Authors

Christian Schlatzer¹, Daniel J Bratton¹, Sonja E Craig², Malcolm Kohler³, John R Stradling²

Affiliations

¹ Sleep Disorders Centre and Pulmonary Division, University Hospital Zürich, Zürich, Switzerland.
² Oxford Centre for Respiratory Medicine and NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
³ Sleep Disorders Centre and Pulmonary Division, University Hospital Zürich, Zürich, Switzerland Zürich Centre for Integrative Human Physiology, University of Zürich, Zürich, Switzerland.

Abstract

Objective: Obstructive sleep apnoea (OSA), atrial fibrillation (AF) and sudden cardiac death (SCD) may occur concomitantly, and are of considerable epidemiological interest, potentially leading to morbidity and mortality. Effective treatment of OSA with continuous positive airway pressure (CPAP) could prevent progression and/or recurrence of AF and factors leading to SCD. Recently, a randomised controlled trial showed a statistically and clinically significant prolongation of measures of cardiac repolarisation after CPAP withdrawal in symptomatic patients with moderate to severe OSA. Whether or not CPAP therapy improves ECG risk markers of AF and SCD in patients with minimally symptomatic OSA as well, is unknown.

Methods: 3 centres taking part in the MOSAIC (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular) trial randomised 303 patients with minimally symptomatic OSA to receive either CPAP or standard care for 6 months. Treatment effects of CPAP on P-wave duration, P-wave dispersion, QT interval, QT dispersion, Tpeak-to-Tend (TpTe) and TpTe/QT ratio were analysed.

Results: Participants were primarily men (83%). Mean age was 57.8 (7.2) and mean ODI (Oxygen Desaturation Index) at baseline was 13.1/h (12.3). Full 12-lead ECG data was available in 250 patients. Mean (SD) baseline intervals of P-wave duration, P-wave dispersion, QTc interval, QT dispersion, TpTe and TpTe/QT ratio in ms were 87.4 (8.3), 42.3 (11.9), 397.8 (22.7), 43.1 (16.7), 73.5 (13.7) and 0.19 (0.0), respectively. No treatment effect of CPAP on risk markers for AF and SCD was found.

Conclusions: There seems to be no effect of CPAP on ECG measures of arrhythmia risk in patients with minimally symptomatic OSA.

Trial registration number: ISRCTN34164388; Post-results.

Keywords: Atrial fibrillation; Continuous positive airway pressure; Electrocardiogram; Obstructive sleep apnoea; Risk marker; Sudden cardiac death.

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Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Atrial Fibrillation / etiology*
Atrial Fibrillation / mortality
Atrial Fibrillation / physiopathology
Canada / epidemiology
Continuous Positive Airway Pressure* / adverse effects
Continuous Positive Airway Pressure* / mortality
Death, Sudden, Cardiac / etiology*
Death, Sudden, Cardiac / prevention & control
Electrocardiography*
Female
Humans
Male
Middle Aged
Patient Compliance / statistics & numerical data*
Risk Assessment
Risk Factors
Sleep Apnea, Obstructive / complications*
Sleep Apnea, Obstructive / mortality
Sleep Apnea, Obstructive / physiopathology
Treatment Outcome
United Kingdom / epidemiology

Associated data

ISRCTN/ISRCTN34164388

Grants and funding

British Heart Foundation/United Kingdom