Obstructive sleep apnea (OSA) is a major modifiable risk factor for atrial fibrillation (AF). Continuous positive airway pressure (CPAP) therapy has been shown to improve cardiovascular outcomes; however, real-world data on its effect on AF recurrence remain limited.

This prospective cohort study aims to evaluate the association between objective CPAP adherence and the risk of AF recurrence in patients with moderate-to-severe OSA and a history of paroxysmal AF.

Patients will be followed for 12 months, with AF recurrence assessed using electrocardiography and Holter monitoring.

This is a prospective, real-world cohort study enrolling adult patients with moderate-to-severe obstructive sleep apnea (AHI ≥ 15 events/hour) and documented paroxysmal atrial fibrillation. OSA is diagnosed using home sleep apnea testing.

All participants initiate CPAP therapy, with objective adherence data collected via telemonitoring. Patients are followed for 12 months to assess AF recurrence, progression to permanent AF, and associations with CPAP usage metrics.

Inclusion Criteria:

1. Age ≥ 18 years
2. Diagnosed moderate-to-severe OSA
3. History of paroxysmal atrial fibrillation
4. Ability to initiate CPAP therapy
5. Written informed consent -

Exclusion Criteria:

1. Left ventricular ejection fraction < 50%
2. Permanent atrial fibrillation
3. Central sleep apnea
4. End-stage chronic kidney disease
5. Inability to obtain or tolerate CPAP therapy -

Adult patients diagnosed with moderate-to-severe obstructive sleep apnea and a history of paroxysmal atrial fibrillation, managed in outpatient and hospital settings, and treated with continuous positive airway pressure therapy as part of routine clinical care.

Individual participant data will not be shared due to data protection regulations and the absence of explicit participant consent for data sharing beyond the scope of the current study.