Continuous positive airway pressure reduces nocturnal arrhythmia avalanche burden in obstructive sleep apnea: An adherence-dependent effect

Shahrbabaki, SS; Mittinty, M; Tonchev, IR; Strong, C; Chapman, D; Lorensini, S; Jenkins, E; Catcheside, P; Adams, R; Eckert, DJ; Sanders, P; Ganesan, AN

doi:10.1016/j.hrthm.2025.12.015

Continuous positive airway pressure reduces nocturnal arrhythmia avalanche burden in obstructive sleep apnea: An adherence-dependent effect

Heart RhythmPublished 12 Dec 2025Secondary analysis of the Heart Biomarker Evaluation in Apnea Treatment randomised trial

Primary result · Change in NAA burdenResultChange 260 episodes 95% CI −510.5 to −9.5

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Authors' conclusion

CPAP therapy produces an adherence-dependent reduction in nocturnal arrhythmic burden in patients with OSA.

Study context

Population: Patients with obstructive sleep apnea (OSA) (apnea-hypopnea index 15–50 events/h)complete ECG data
Participants: 245 patients

Comparison: Continuous positive airway pressure (CPAP) vs Control
Primary endpoint: Change in nocturnal arrhythmia avalanche (NAA) burden

Primary result

Change in NAA burden

Change

260 episodes

95% CI −510.5 to −9.5

P = 0.024

As reported in the abstract

Secondary outcomes

Outcome	Difference (NAAs) (95% CI)	P value
NAAs per additional day of effective CPAP use (≥4 h/night)Fewer; 14% reduction/adherent-night	88.8 (−149.2 to −28.5)	P = 0.004

Modifiers of CPAP effectiveness

High BMI reduced CPAP effectiveness: P = 0.009
Smoking reduced CPAP effectiveness: P = 0.015

Original publication

Continuous positive airway pressure reduces nocturnal arrhythmia avalanche burden in obstructive sleep apnea: An adherence-dependent effect. Heart Rhythm. Published 12 December 2025. doi:10.1016/j.hrthm.2025.12.015

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Summarised from the published abstract; every number is checked against it