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Meta-Analysis
. 2017 Sep 1;12(9):e0184293.
doi: 10.1371/journal.pone.0184293. eCollection 2017.

Effect of continuous positive airway pressure on carotid intima-media thickness in patients with obstructive sleep apnea: A meta-analysis

Li-Da Chen  1 , Li Lin  1 , Xue-Jun Lin  2 , Yang-Wu Ou  1 , Zhi Wu  1 , Yu-Ming Ye  1 , Qiao-Zhen Xu  1 , Ya-Ping Huang  1 , Zhi-Ming Cai  1
Affiliations
Meta-Analysis

Effect of continuous positive airway pressure on carotid intima-media thickness in patients with obstructive sleep apnea: A meta-analysis

Li-Da Chen et al. PLoS One. .

Abstract

Objective: Obstructive sleep apnea (OSA) is associated with increased carotid intima-media thickness (IMT), an early marker of atherosclerosis. Continuous positive airway pressure (CPAP) is the first-line treatment for OSA. A meta-analysis was performed to determine whether CPAP therapy could decrease carotid IMT.

Methods: The PubMed, Embase, Web of Science, and Cochrane library were searched before March, 2017. Weighted mean difference (WMD) was calculated to estimate the treatment effects of pre and post-CPAP therapy. Seven studies were examined and the meta-analysis was performed using STATA 12.0.

Results: There was no change of carotid IMT before and after CPAP treatment in OSA patients (WMD = 0.052, 95% confidence interval (CI) = -0.002 to 0.105, z = 1.90, p = 0.057). Meanwhile, meta-analysis of the two RCTs showed that carotid IMT was not changed in CPAP group when compared with control group (WMD = 0.002 95% CI = -0.125 to 0.129, z = 0.03, p = 0.976). Subgroup analyses indicated that carotid IMT was significantly decreased after CPAP use in more severe OSA patients (AHI≥50) (WMD = 0.073, 95% CI = 0.022 to 0.124, z = 2.80, p = 0.005) and patients with therapeutic duration ≥6 months (WMD = 0.121, 95% CI = 0.019 to 0.223, z = 2.32, p = 0.021).

Conclusions: CPAP had no impact on carotid IMT in OSA patients. However, carotid IMT was significantly decreased after CPAP treatment in more severe OSA patients and patients with longer CPAP usage.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection.
Fig 2
Fig 2. Forest plot for the change in carotid IMT before and after CPAP treatment.
Abbreviation: CPAP = continuous positive airway pressure, IMT = intima-media thickness WMD = weighted mean difference.
Fig 3
Fig 3. Forest plot for the change in carotid IMT between CPAP treatment group and control group in two RCTs.
Abbreviation: CPAP = continuous positive airway pressure, IMT = intima-media thickness WMD = weighted mean difference.
Fig 4
Fig 4. Sensitivity analysis of the included studies.
Abbreviation: CI = confidence interval.
Fig 5
Fig 5. Funnel plots for assessing publication bias of studies included.
SE = standard error, WMD = weighted mean difference.
See this image and copyright information in PMC

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