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Meta-Analysis
. 2014 Jan;37(1):57-65.
doi: 10.1002/clc.22201.

The effects of continuous positive airways pressure therapy on cardiovascular end points in patients with sleep-disordered breathing and heart failure: a meta-analysis of randomized controlled trials

Saurabh Aggarwal, Rashid Nadeem, Rohit S Loomba, Mahwish Nida, Dorice Vieira
Meta-Analysis

The effects of continuous positive airways pressure therapy on cardiovascular end points in patients with sleep-disordered breathing and heart failure: a meta-analysis of randomized controlled trials

Saurabh Aggarwal et al. Clin Cardiol. 2014 Jan.

Abstract

In patients with sleep-disordered breathing and heart failure, continuous positive airway pressure has been found to be associated with an improvement in cardiovascular end points. We conducted a systematic review of the current literature and a meta-analysis to pool data from 15 published randomized controlled trials. End points analyzed were left ventricular ejection fraction, diastolic blood pressure, systolic blood pressure, heart rate, and mortality. A fixed effects model was used for end points demonstrating homogeneity among included studies, whereas a random effects model was used for end points demonstrating heterogeneity among included studies. A significant improvement in left ventricular ejection fraction was noted with continuous positive airway pressure (mean difference, 5.05%; 95% confidence interval [CI]: 3.72 to 6.38), diastolic blood pressure (mean difference, −1.67; 95% CI: −3.09 to −0.25), and heart rate (mean difference, −5.92; 95% CI: −10.12 to−1.72). No significant changes in mortality (odds ratio, 0.63; 95% CI: 0.40 to 1.00) and systolic blood pressure were noted (mean difference, −6.35; 95% CI: −16.11 to 2.41). The analysis also revealed the need for additional studies to clarify the associations noted and the presence of publication bias with small studies with a paucity of small studies with negative results. In this meta-analysis, treatment with continuous positive airways pressure was associated with improvements in ejection fraction, diastolic blood pressure, and heart rate in patients with sleep-disordered breathing and congestive heart failure.

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Figures

Figure 1
Figure 1
Study selection methodology.
Figure 2
Figure 2
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on left ventricular ejection fraction (LVEF) in patients with OSA and congestive heart failure. Abbreviations: CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 3
Figure 3
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea on left ventricular ejection fraction in patients with central sleep apnea or Cheyne‐Stokes respiration. Abbreviations: CI, confidence interval; EF, ejection fraction; IV, inverse variance; SD, standard deviation.
Figure 4
Figure 4
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on left ventricular ejection fraction in patients with predominantly OSA. Abbreviations: CI, confidence interval; EF, ejection fraction; IV, inverse variance; SD, standard deviation.
Figure 5
Figure 5
Effect of age on change in Ejection fraction with CPAP treatment for OSA‐ Regression analysis.
Figure 6
Figure 6
Effect of BMI on change in Ejection fraction with CPAP treatment for OSA‐ Regression analysis.
Figure 7
Figure 7
Effect of AHI on change in Ejection fraction with CPAP treatment for OSA‐ Regression analysis.
Figure 8
Figure 8
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on diastolic blood pressure (DBP) in patients with OSA. Abbreviations: CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 9
Figure 9
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on systolic blood pressure (SBP) in patients with OSA. Abbreviations: CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 10
Figure 10
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on heart rate (HR) in patients with OSA. Abbreviations: CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 11
Figure 11
Forest plot of the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on mortality in patients with OSA. Abbreviations: CI, confidence interval; M‐H, Mantel‐Haenszel.
Figure 12
Figure 12
All funnel plots. Abbreviations: MD, mean difference; OR, odd ratio; SE, standard error.
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