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in our review given that we defined post–coronary artery bypass graft atrial fibrillation (PCAF) as an episode of AF from the end of the operation to hospital discharge. This is consistent with their study because they define new-onset AF as a postoperative complication during the hospital stay.
was eligible for our review, we conducted a subgroup analysis by excluding it for different reasons (Fig. 1). This analysis was deemed of lesser importance, and we omitted it from our review to provide readers with a more concise message. Comparing Figure 1 in this letter to Figure 2 of our review,
resulted in obstructive sleep apnea (OSA) being a stronger predictor of PCAF (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.59-3.06] vs OR, 1.86; 95% CI, 1.24-2.80). In addition, removing this study substantially reduced detected heterogeneity (I2 < 0.01% vs I2 = 35%).
Figure 1Association between obstructive sleep apnea (OSA) and post–coronary artery bypass graft atrial fibrillation without the study by Sharma et al.
with all data evaluating OSA by polysomnography to assess the sensitivity of the pooled analysis to variations in OSA severity across studies. Figure 3B showed an increased risk of PCAF compared with Figure 3A, suggesting that severe OSA may influence the association.
Evidently, this analysis is not sufficient to conclude that the risk of PCAF increases with OSA severity, and we acknowledged this as a limitation in our review. Our results provide an impetus for future studies to investigate this important question.
Regarding the comment about the cutoff value for severe OSA, > 30 on the apnea-hypopnea index is the standard for severe OSA in the literature. This is consistent with Grilli et al., the only study that stratified their results by OSA severity in our review.
We read with great interest the report by Qaddoura et al. in the Canadian Journal of Cardiology.1 This article reported the predicted value of obstructive sleep apnea (OSA) on post–coronary artery bypass graft atrial fibrillation (PCAF). We congratulate the authors for conducting this wonderful study because they concluded that OSA might be a strong predictor of PCAF through this comprehensive meta-analysis.
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