Clinical outcomes and dynamics of brain natriuretic peptide, blood biomarkers of fibrosis and inflammation, echocardiographic parameters during non-invasive respiratory therapy in patients with atrial fibrillation and obstructive sleep apnea

Objective — to investigate clinical outcomes and dynamics of brain natriuretic peptide, blood levels of fibrosis and inflammation biomarkers, echocardiographic parameters against the background of non-invasive respiratory therapy in patients with atrial fibrillation (AF) and obstructive sleep apnea (OSA). Design and methods. The study included 239 patients with obstructive sleep apnea verified by night respiratory monitoring. All examined patients underwent anthropometric measurements, transthoracic echocardiography, and determined concentrations of fibrosis and inflammation biomarkers, and N-terminal precursor of brain natriuretic peptide. Patients with atrial fibrillation and moderate-to-severe OSA were included in the prospective branch of the study, 21 patients regularly used non-invasive respiratory therapy (PAP-therapy), 80 patients did not receive regular respiratory support. After 1 year of follow-up, echocardiographic parameters, blood biomarker levels, and clinical outcomes were re-evaluated. Results. AF was more common in patients with moderate-to-severe OSA than in those with mild sleep- disordered breathing (p = 0,009 and p = 0,004, respectively). Blood concentrations of brain natriuretic peptide, fibrosis biomarkers (galectin-3, GDF-15, CTGF) and inflammation (interleukin-6) decreased after 12 months of PAP-therapy (p < 0,0001), while they did not change in patients who did not use PAP-therapy regularly. Echocardiographic parameters characterizing atrial remodeling (size, volume, and volume indices of both atria), as well as pulmonary artery size and pulmonary artery pressure decreased with the use of noninvasive respiratory therapy (p < 0,05). The use of PAP-therapy reduced the risk of recurrent AF by 54,4 % (OR = 0,46, 95 % CI 0,25–0,84, p < 0,01), the clinical composite endpoint by 31,6 % (OR = 0,68, 95 % CI 0,50–0,93, p < 0,01), and the prognostic composite endpoint by 76,9 % (OR = 0,23, 95 % CI 0,06–0,89, p = 0,007). Conclusion. The regular use of PAP-therapy as part of a complex treatment in patients with moderate-tosevere OSA and AF reduces the risk of arrhythmia recurrence, arterial hypertension without achieving target blood pressure, clinical and prognostic combined endpoints, and is accompanied by a decrease in blood concentrations of proinflammatory and profibrogenic markers and atrial dilation, and a decrease in pulmonary artery pressure.

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