Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis.
TLDR
The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea, and these findings do not support treatment with PAP with a goal of prevention of these outcomes.Abstract:
Importance Sleep apnea (obstructive and central) is associated with adverse cardiovascular risk factors and increased risks of cardiovascular disease. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV), but the associations with cardiovascular outcomes and death are unclear. Objective To assess the association of PAP vs control with cardiovascular events and death in patients with sleep apnea. Data Sources and Study Selection MEDLINE, EMBASE, and the Cochrane Library were systematically searched from inception date to March 2017 for randomized clinical trials that included reporting of major adverse cardiovascular events or deaths. Data Extraction and Synthesis Two authors independently extracted data using standardized forms. Summary relative risks (RRs), risk differences (RDs) and 95% CIs were obtained using random-effects meta-analysis. Main Outcomes and Measures The main outcomes were a composite of acute coronary syndrome (ACS) events, stroke, or vascular death (major adverse cardiovascular events); cause-specific vascular events; and death. Results The analyses included data from 10 trials (9 CPAP; 1 ASV) of patients with sleep apnea (N = 7266; mean age, 60.9 [range, 51.5 to 71.1] years; 5847 [80.5%] men; mean [SD] body mass index, 30.0 [5.2]. Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse cardiovascular events (RR, 0.77 [95% CI, 0.53 to 1.13]; P = .19 and RD, −0.01 [95% CI, −0.03 to 0.01]; P = .23), cardiovascular death (RR, 1.15 [95% CI, 0.88 to 1.50]; P = .30 and RD −0.00 [95% CI, −0.02 to 0.02]; P = .87), or all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P = .08 and RD, 0.00 [95% CI, −0.01 to 0.01]; P = .51). The same was true for ACS, stroke, and heart failure. There was no evidence of different associations for CPAP vs ASV (all P value homogeneity >.24), and meta-regressions identified no associations of PAP with outcomes for different levels of apnea severity, follow-up duration, or adherence to PAP (all P values > .13). Conclusions and Relevance The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea. Although there are other benefits of treatment with PAP for sleep apnea, these findings do not support treatment with PAP with a goal of prevention of these outcomes.read more
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Effect of Obstructive Sleep Apnoea and Its Treatment With Continuous Positive Airway Pressure on the Prevalence of Cardiovascular Events in Patients With Acute Coronary Syndrome (ISAACC Study): A Randomised Controlled Trial
Manuel Sánchez-de-la-Torre,Alicia Sánchez-de-la-Torre,Sandra Bertran,Jorge Abad,Joaquín Durán-Cantolla,Valentin Cabriada,Olga Mediano,María José Masdeu,Mari Luz Alonso,Juan F. Masa,Antonia Barceló,Mónica de la Peña,Mercè Mayos,Ramón Coloma,Josep M. Montserrat,Eusebi Chiner,Salvador Perelló,Gemma Rubinós,Olga Minguez,Lydia Pascual,Anunciación Cortijo,Dolores Martínez,Albina Aldomá,Mireia Dalmases,R. Doug McEvoy,Ferran Barbé,Laura Abad,Aida Muñoz,Elisabet Zamora,Ignacio Vicente,Sandra Inglés,Carlos Egea,Jaime Marcos,Almudena Fernández,Jorge Ullate,Joaquín Durán Carro,Jose L Rodríguez,María J Mendoza,Raul Labeaga,David Diez,Berenice Muria,Chechu Amibilia,Amaia Urrutia,Sonia Castro,Leyre Serrano,Idoia Salinas,Ruth Diez,Ana Martínez,Marina Florés,Estefanía Galera,Anna Mas,Montserrat Martínez,Maricel Arbonés,Silvia Ortega,Alicia Martín,Jose M Román-Sánchez,Ma Isabel Valiente-Diaz,Ma Esther Viejo-Ayuso,Concepción Rodríguez-García,Noelia Sánchez-Rodríguez,Nieves Mayoral,Francisco J Rubio,Yunelsy Anta-Mejias,Sofía Romera-Peralta,Pilar Resano,Ramón Arroyo-Espilguero,María Bienvenido-Villalba,Laura Vigil,Enriqueta Ramírez,María Piñar,Elisabet Martínez,Carmen Muñoz,Estrella Ordax,Name Surname,Jaime Corral,Francisco J Gómez de Terreros Caro,Estefanía García-Ledesma,Rocío Gallego,Jose L Cabrero,Ricardo Pereira,Paloma Giménez,Miguel Carrera,Javier Piérola,Cristina Villena,Magdalena Campaner,Ana María Fortuna,Patricia Peñacoba,Abel J Martínez García,Sergio García Castillo,Lara Navas,Onintza Garmendia,Monique Suárez,José Sancho,Núria Farré,Gil Bonet,Alfredo Bardají,Anna Villares,Ma José Vázquez +97 more
TL;DR: Among non-sleepy patients with ACS, the presence of OSA was not associated with an increased prevalence of cardiovascular events and treatment with CPAP did not significantly reduce this prevalence.
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