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Sleep Disordered BreathingNCT02727192

Effect of Treatment of Sleep Apnea in Patients With Paroxysmal Atrial Fibrillation

A study testing PAP (CPAP or ASV) in people with Sleep Disordered Breathing and Sleep Apnea, run by Oslo University Hospital at 1 site in Norway.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Atrial fibrillation (AF) is the most common cardiac rhythm disturbance in adults, with prevalence expected to rise significantly the coming decades. The occurrence of AF is associated with significantly increased mortality as well as morbidity of which cerebrovascular accidents is the most important. Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
PAP (CPAP or ASV)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
109 participants
Where
1 siteNorway
Study dates
21 Jan 2016to Sep 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-75 years
  • Male or female
  • Patients with paroxysmal AF scheduled for first or second catheter ablation
  • Moderate-to-severe SA defined as an AHI ≥15/h (OSA and/or CSA)
  • Signed informed consent

Who cannot join

  • Unstable patients
  • Patients with left ventricular ejection fraction (LV-EF) < 45%
  • Unstable coronary artery disease, myocardial infarction or PCI within 3 months prior to the study
  • Bypass surgery within 6 months prior to the study
  • Patients with TIA or stroke within the previous 3 months
  • BMI > 40kg/m2
Show all 13Show fewer
  • Drowsy drivers and/or sleepy patients with ESS (Epworth Sleepiness Score) > 15
  • Patients with interstitial lung diseases, severe obstructive lung defects, and thoracic myopathies or severe obstructive lung defects with FEV1 < 50% of predicted
  • Oxygen saturation < 90% at rest during the day
  • Poor compliance
  • Patients with single chamber pacemaker (or ICD)
  • Current use of PAP therapy
  • Patients using amiodarone

Trial locations and contacts

1 site in 1 country.

Norway1 site
  • Oslo University Hospital

    Oslo, 0424

Other trials in Norway

About this study

Official title: Sleep Disordered Breathing in Patients With Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac rhythm disturbance in adults, with prevalence expected to rise significantly the coming decades. The occurrence of AF is associated with significantly increased mortality as well as morbidity of which cerebrovascular accidents is the most important. Unfortunately treatment options remain limited. Anti-arrhythmic drugs are widely used but have limited efficacy and the potential for toxicity and adverse events are recognized. Recent year's catheter ablation of AF continues to gain acceptance for symptomatic treatment, but recurrence rate are high with need for continuous medication. Thus there is a need to better understand what causes development and triggers episodes of AF as well to introduce new treatment options. Cardiometabolic factors such as obesity, inactivity and sleep apnea (SA) have therefore gained interest. Many patients with AF have chronic sleep apnea, and in the present study the investigators want to explore the interaction between SA and AF. The hypothesis of the present study is that SA may trigger AF and that treatment of SA will reduce the overall burden of AF as well as reduce the recurrence of AF after pulmonary vein ablation. To test the hypothesis the investigators will implant a Reveal device that continuously records the hearts rhythm of 100 patients with paroxysmal AF and concomitant SA. Initially the influence of SA on onset of AF will be examined, and the patients will then be randomized to treatment of SA or not and the influence on total AF burden recorded both before and after ablation.

Read the detailed description

For the present project the investigators have established a research team from 2 different university hospitals. This team, including high ranked, internationally renowned scientist from both clinical and basic sciences, will make a framework for PhD candidates and will ensure the patient cohort. Patients with paroxysmal AF and SA will be examined with an extensive diagnostic battery including advanced cardiac imaging tools allowing a proper description of the heart. Then a Reveal that continuously monitor the rhythm of the heart will be inserted, allowing the influence of SA, physical activity, inflammatory parameters, and other external variables on total AF burden to be examined. The patients will then be randomized to treatment of SA with a CPAP or not, and the AF burden recorded 6 months before ablation and 6 months after.

The present investigations carried out, are expected to results in better understanding of the interaction between AF and SA and may lay the scientific basis for better diagnostic and therapeutic approaches for patients with AF. In addition, given the advantage of continuous Reveal® recording of the patient's heart rhythm, the present study will examine possible triggers of AF such as activity level and inflammatory substances, and examine the role of structural abnormalities in the heart as assessed by echocardiography for the triggering of AF episodes. An overall aim is therefore a better phenotyping of the patient which could aid in a more person-specific treatment approach, with direct consequences both for the individual patient and for the society.

Being tested
PAP (CPAP or ASV)
Keywords
Atrial fibrillation, CPAP, Sleep apnea, Sleep disordered breathing
Medical subject headings
Sleep Apnea Syndromes, Atrial Fibrillation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PAP (CPAP or ASV)Device

    Patients will be randomized to treatment of Sleep Apnea with a CPAP or control

Study groups in NCT02727192
Study groupRoleWhat they receive
PAP-therapy (CPAP or ASV)Active comparatorPatients are randomized to either intervention Group: Positive airway pressure therapy (PAP-therapy) or Control. Patients in the intervention arm will be treated with PAP-therapy (Continous Positive Airway Pressure (CPAP) or Adaptive Servo Ventilation (ASV).
Receives: Device: PAP (CPAP or ASV)
Control groupNo interventionNo sleep apnea treatment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in AF Burden

    Difference between PAP treatment and usual care in change of AF burden (% of time in AF, as measured by loop recorder) from baseline (one month prior to randomization) to the last three months of the five month intervention period.

    Measured: Baseline (pre-randomization) was the first month of loop recorder data collection and was compared to the last three months of the intervention period.

Secondary outcomes (17)
  1. Change in AF Burden

    Difference between PAP treatment and usual care in change of AF burden (% of time in AF, as measured by loop recorder) from baseline (one month prior to randomization) to the last month of the intervention period.

    Measured: Baseline to the last month of intervention period

  2. Change in AF Burden

    Difference between PAP treatment and usual care in change of AF burden (% of time in AF, as measured by loop recorder) from baseline (one month prior to randomization) to the last five months of the intervention period (the whole intervention period).

    Measured: Comparing Baseline to the last five months of the intervention period

  3. Number of Participants With More Than 25% Reduction in AF Burden

    Difference between PAP treatment and usual care in the proportion of patients with at least 25% reduction of AF burden (% of time in AF, as measured by loop recorder) from baseline (one month prior to randomization) to the last three months of the intervention period.

    Measured: Baseline to last three months of the intervention

  4. Change of Recurrence Rate After Ablation, as Measured by Loop Recorder

    Change of recurrence rate after ablation, as measured by loop recorder, after 6 months post ablation and after 12 months post ablation.

    Measured: 12 months

  5. Change in AF Symptoms as Assessed by Atrial Fibrillation Severity Scale (AFSS)

    Change in AF symptoms between CPAP treatment and usual care. The questionnaire quantifies three domains of AF: event frequency (score 1-10), duration (score 1-10), and global episode severity (score 1-10). The total AF burden is calculated from the modified sum of the frequency, duration, and severity of AF (score 3-30, with higher scores indicating greater AF burden ). In addition, the AFSS assesses a symptom score based on seven items asking how bothered patients are by specified symptoms (score 0-35). Global well-being is a visual analogue scale ranging from 1 to 10 (10 indicating the best possible life).

    Measured: 6 months, 12 months and 18 months

  6. Change in Quality of Life (QoL) as Assessed by Medical Outcomes Study 36-item Short-Form Health Survey (SF-36)

    Difference between CPAP and usual care in QoL as assessed by SF36, Version 1.2. Item scores are transformed into the Physical and Mental Component Summary scores (PCS and MCS). Scores range from 0 to 100, with higher scores indicating a better health state.

    Measured: Assessed at baseline, 6 months, 12 months and 18 months, baseline and 6 months reported.

  7. Change in Sleep Quality and Symptoms of Sleep Apnea: Epworth Sleepiness Scale (ESS) Score

    Difference between PAP treatment and usual care in Change in daytime sleepiness as measured using the Epworth Sleepiness Scale (ESS) score, with scores ranging from 0 to 24 (most sleepy)

    Measured: 6 months, 12 months and 18 months. Baseline and 6 months reported

  8. Change in Symptoms of Obstructive Sleep Apnea Assessed by the Berlin Questionnaire.

    Change in sleep quality and symptoms of obstructive sleep apnea as measured using the Berlin Questionnaire. Positive scores in two or more categories suggest a high risk of OSA.

    Measured: 6 months, 12 months and 18 months

  9. Change in Symptoms of Sleep Apnea Using the Functional Outcomes of Sleep Questionnaire (FOSQ)

    Change in sleep quality and symptoms of obstructive sleep apnea as measured using the Functional Outcomes of Sleep Questionnaire (FOSQ). Score range is 5-20 Points, with higher scores indicating better functional status.

    Measured: 6 months, 12 months and 18 months. Baseline and 6 months reported.

  10. Change in Symptoms of Sleep Apnea Measured by the STOP-Bang

    Change in sleep quality and symptoms of obstructive sleep apnea as measured using the STOP-Bang Questionnaire. Score between 0-8. A score of ≥3 suggest risk for OSA.

    Measured: 6 months, 12 months and 18 months

  11. Change in CRP

    Difference between PAP treatment and usual care in change of CRP

    Measured: 6 months, 12 months and 18 months. Baseline and 6 months reported.

  12. Change in Left Ventricular Ejection Fraction

    Difference between PAP treatment and usual care in change of left ventricular ejection fraction as assessed by ecco

    Measured: 6 months, 12 months and 18 months. Baseline and 6 months reported.

  13. Change in the Cardiac Marker NT-proBNP.

    Difference between PAP treatment and usual care in change of Cardiac marker of NT-proBNP.

    Measured: 6 months, 12 months. Baseline and 6 months reported.

  14. Examine the Effect of SA Treatment on Gene Expression of White Blood Cells.

    Examine the effect of SA treatment on gene Expression of white blood cells. Is paroxysmal AF Associated with specific gene Expression patterns? Examine the influence of SA treatment on the pattern of gene Expression and if this is related to reduction of atrial fibrillation burden

    Measured: 6 months and 12 months

  15. Examine if Onset of Paroxysmal AF is Associated With Specific Activity Patterns, as Assessed by Garmin Vivofit2/3, Activity Recording

    Examine if onset of paroxysmal AF is Associated with specific Activity patterns, as assessed by garmin Vivofit2/3, Activity recording

    Measured: 6 months and 12 months

  16. Change in Body Composition as Assessed by Bioelectric Impedance Analysis (BIA) (Tanita)

    Change in body composition (BMI) as assessed by Bioelectric Impedance Analysis (BIA) (Tanita)

    Measured: Baseline to follow up 6 months

  17. Lung Function Test as Assessed by Spirometry

    Lung function test as assessed by spirometry

    Measured: Baseline, 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Apr 2016 (estimated)
  2. Study start21 Jan 2016
  3. Primary completion1 Jul 2019
  4. Study completionSep 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
109 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02727192
Sponsor's protocol ID
Gullestad
Status last verified
May 2021
First submitted
29 Mar 2016
Last updated
22 Jun 2021
Data monitoring committee
Yes

Publications

  • Ueland T, Traaen GM, Hunt TE, Aakeroy L, Overland B, Bendz C, Michelsen AE, Steinshamn S, Anfinsen OG, Aukrust P, Broch K, Akre H, Loennechen JP, Gullestad L. High levels of the adipokines leptin and metrnl in patients with paroxysmal atrial fibrillation and obstructive sleep apnea are not associated with the severity of sleep apnea or the burden of atrial fibrillation. Sleep Med. 2025 Dec;136:106862. doi: 10.1016/j.sleep.2025.106862. Epub 2025 Oct 16.

    PubMed 41110405
  • Traaen GM, Aakeroy L, Hunt TE, Overland B, Bendz C, Sande LO, Aakhus S, Fagerland MW, Steinshamn S, Anfinsen OG, Massey RJ, Broch K, Ueland T, Akre H, Loennechen JP, Gullestad L. Effect of Continuous Positive Airway Pressure on Arrhythmia in Atrial Fibrillation and Sleep Apnea: A Randomized Controlled Trial. Am J Respir Crit Care Med. 2021 Sep 1;204(5):573-582. doi: 10.1164/rccm.202011-4133OC.

    PubMed 33938787
  • Traaen GM, Aakeroy L, Hunt TE, Overland B, Lyseggen E, Aukrust P, Ueland T, Helle-Valle T, Steinshamn S, Edvardsen T, Khiabani Zare H, Aakhus S, Akre H, Anfinsen OG, Loennechen JP, Gullestad L. Treatment of sleep apnea in patients with paroxysmal atrial fibrillation: design and rationale of a randomized controlled trial. Scand Cardiovasc J. 2018 Dec;52(6):372-377. doi: 10.1080/14017431.2019.1567933. Epub 2019 Feb 5.

    PubMed 30638392

Questions about this trial

What is this clinical trial studying?

A study testing PAP (CPAP or ASV) in people with Sleep Disordered Breathing and Sleep Apnea, run by Oslo University Hospital at 1 site in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Jun 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Jun 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in AF Burden (time frame: Baseline (pre-randomization) was the first month of loop recorder data collection and was compared to the last three months of the intervention period.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02727192, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jun 2021.

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