TY - JOUR
T1 - Meta-Analysis of Cardiovascular Outcomes With Continuous Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea
AU - Abuzaid, Ahmed S.
AU - Al Ashry, Haitham S.
AU - Elbadawi, Ayman
AU - Ld, Ha
AU - Saad, Marwan
AU - Elgendy, Islam Y.
AU - Elgendy, Akram
AU - Mahmoud, Ahmed N.
AU - Mentias, Amgad
AU - Barakat, Amr
AU - Lal, Chitra
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/8/15
Y1 - 2017/8/15
N2 - Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the main treatment of OSA. The present study explores the impact of CPAP on cardiovascular outcomes. A systematic search of electronic databases for randomized controlled trials comparing CPAP with medical therapy alone in patients with OSA who reported cardiovascular outcomes of interest was performed. The main outcome was major adverse cardiac events. Other outcomes included cardiac mortality, myocardial infarction, angina pectoris, stroke, and transient ischemic attack. Fixed effect model was used in all analyses except for subgroup analysis in which the random effect DerSimonian and Laird's model was used. Four randomized controlled trials with a total of 3,780 patients were included. Compared with medical therapy alone, CPAP use was not associated with reduced risk of major adverse cardiac events (relative risk [RR] 0.94, 95% confidence interval [CI] 0.78 to 1.15, p = 0.93, I2 = 0%) except in the subgroup that wore CPAP >4 hours (RR 0.70, 95% CI 0.52 to 0.94, p = 0.02, I2 = 0%). Furthermore, no reduction in the risk of cardiac mortality (RR 1.14, 95% CI 0.66 to 1.97, p <0.36, I2 = 2%), myocardial infarction (RR 0.96, 95% CI 0.64 to 1.44, p <0.15, I2 = 47%), angina pectoris (RR 1.16, 95% CI 0.9 to 1.50, p <0.51, I2 = 0%), stroke (RR 1.01, 95% CI 0.73 to 1.38, p <0.0.86, I2 = 0%), and transient ischemic attack (RR 1.36, 95% CI 00.69 to 2.68, p <0.24, I2 = 30%) was observed. Subgroup analysis of CPAP adherence in regards to cardiac outcomes showed that CPAP use is not associated with decreased risk of heart failure (RR 0.91, 95% CI 0.50 to 1.66, p <0.55, I2 = 0%). In conclusion, compared with medical therapy alone, utilization of CPAP in patients with OSA is not associated with improved cardiac outcomes except in patients who wore it for >4 hours.
AB - Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the main treatment of OSA. The present study explores the impact of CPAP on cardiovascular outcomes. A systematic search of electronic databases for randomized controlled trials comparing CPAP with medical therapy alone in patients with OSA who reported cardiovascular outcomes of interest was performed. The main outcome was major adverse cardiac events. Other outcomes included cardiac mortality, myocardial infarction, angina pectoris, stroke, and transient ischemic attack. Fixed effect model was used in all analyses except for subgroup analysis in which the random effect DerSimonian and Laird's model was used. Four randomized controlled trials with a total of 3,780 patients were included. Compared with medical therapy alone, CPAP use was not associated with reduced risk of major adverse cardiac events (relative risk [RR] 0.94, 95% confidence interval [CI] 0.78 to 1.15, p = 0.93, I2 = 0%) except in the subgroup that wore CPAP >4 hours (RR 0.70, 95% CI 0.52 to 0.94, p = 0.02, I2 = 0%). Furthermore, no reduction in the risk of cardiac mortality (RR 1.14, 95% CI 0.66 to 1.97, p <0.36, I2 = 2%), myocardial infarction (RR 0.96, 95% CI 0.64 to 1.44, p <0.15, I2 = 47%), angina pectoris (RR 1.16, 95% CI 0.9 to 1.50, p <0.51, I2 = 0%), stroke (RR 1.01, 95% CI 0.73 to 1.38, p <0.0.86, I2 = 0%), and transient ischemic attack (RR 1.36, 95% CI 00.69 to 2.68, p <0.24, I2 = 30%) was observed. Subgroup analysis of CPAP adherence in regards to cardiac outcomes showed that CPAP use is not associated with decreased risk of heart failure (RR 0.91, 95% CI 0.50 to 1.66, p <0.55, I2 = 0%). In conclusion, compared with medical therapy alone, utilization of CPAP in patients with OSA is not associated with improved cardiac outcomes except in patients who wore it for >4 hours.
UR - https://www.scopus.com/pages/publications/85021243427
UR - https://www.scopus.com/pages/publications/85021243427#tab=citedBy
U2 - 10.1016/j.amjcard.2017.05.042
DO - 10.1016/j.amjcard.2017.05.042
M3 - Article
C2 - 28651851
AN - SCOPUS:85021243427
SN - 0002-9149
VL - 120
SP - 693
EP - 699
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -