LAUSR

components of OSA trigger sympathetic activation, blood pressure instability, augmented left ventricular afterload, inflammation, and other AF-related mechanisms. Most of the available data were focused on the impact of OSA on AF in the outpatient setting or in AF recurrence after ablation. The available literature on PCAF is limited to observational studies withmixed populations and combined surgical procedures (2–4). The PAFOS trial is, to our knowledge, the first study to evaluate the impact of CPAP on PCAF. Despite the biological plausibility, OSA treatment was not able to decrease the rate of PCAF in the short-term follow-up, even in those with goodCPAP compliance. As previously observed in other studies, such as SAVE (Continuous Positive Airway Pressure Treatment ofObstructive SleepApnea to Prevent CardiovascularDisease) (5), our populationwas nonsleepy, whichmay have affected acceptance of CPAP in our study. Additional contributors to this low adherence in our study included the challenges of CPAP adaptation in the ICU, postoperative pain, and stress related to the CABGprocedure. The low adherence to CPAPmay be responsible for the lack of difference in the primary study endpoint. Preexposure to CPAP before surgerymay be a crucial strategy to increase treatment adherence in future studies. We need to acknowledge the following additional limitations: 1) our study has a short follow-up, several of the possible beneficial cardiovascular effects of CPAP are medium and long term, and there may not have been time for the reduction of events in the intervention group; and 2) as also observed in hundreds of other trials, our study was severely impacted by the COVID-19 pandemic, limiting the power of this analysis. Therefore, although the PCAF incidence was not different even when comparing good CPAP users with the control group, the sample size was too small to draw definitive conclusions in this research area. In conclusion, in our exploratory study, short-term use of CPAP administered in the immediate postoperative CABG scenario did not reduce PCAF incidence in patients with OSA. Despite the neutral results, the PAFOS trial underscores the need for distinct strategies in future studies, including the selection of targeted patients (e.g., sleepy phenotypes) and preexposure or a run-in phase of CPAP treatment before the surgical procedure.