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Meta-Analysis
. 2023 Dec 1;19(12):2015-2025.
doi: 10.5664/jcsm.10740.

Effects of continuous positive airway pressure on cardiac events and metabolic components in patients with moderate to severe obstructive sleep apnea and coronary artery disease: a meta-analysis

Dan Yang  1 , Liang Li  2 , Junle Dong  1 , Weixian Yang  3   4 , Zhihong Liu  5
Affiliations
Meta-Analysis

Effects of continuous positive airway pressure on cardiac events and metabolic components in patients with moderate to severe obstructive sleep apnea and coronary artery disease: a meta-analysis

Dan Yang et al. J Clin Sleep Med. .

Abstract

Study objectives: This meta-analysis aimed to systematically assess the effects of continuous positive airway pressure (CPAP) in secondary prevention of major cardiovascular events (MACEs) in patients with moderate-to-severe obstructive sleep apnea and coronary artery disease.

Methods: PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched for observational studies and randomized controlled trials that compared CPAP with usual care in patients with moderate-to-severe obstructive sleep apnea with coronary artery disease. The primary outcomes were MACEs, all-cause death, acute coronary syndrome, rehospitalization for heart failure, repeat revascularization, and arrhythmia.

Results: A total of 11 studies (5 randomized controlled trials and 6 observational studies) with 5,410 patients reported outcomes of MACEs. Treatment with CPAP was associated with a modest risk reduction in MACEs (risk ratio [RR] 0.87, 95% confidence interval [CI] 0.78 to 0.98; P = .02). Similarly, CPAP significantly reduced the risk of all-cause and cardiovascular death by 23% (RR 0.77, 95% CI 0.60 to 0.99; P = .04; I2 = 0%). Subgroup analysis revealed that CPAP adherence time ≥ 4 hours/night had a greater benefit on MACEs by 42% (RR 0.58, 95% CI 0.42 to 0.79; P < .001; I2 = 0%) and repeat revascularization by 44% (RR 0.56, 95% CI 0.34 to 0.92; P = .02; I2 = 0%). Also, CPAP had a positive effect on systolic and diastolic blood pressure.

Conclusions: CPAP therapy might prevent subsequent MACEs and all-cause death among patients with moderate to severe obstructive sleep apnea and concomitant coronary artery disease. CPAP use exceeding 4 hours/night may add more benefits on MACEs, repeat revascularization, and blood pressure.

Clinical trial registration: Registry: PROSPERO database; Name: Effects of Continuous Positive Airway Pressure on Cardiovascular Events and Metabolic Components in Patients with Obstructive Sleep Apnea and Coronary Artery Disease; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID= CRD42020213546; Identifier: CRD42020213546.

Citation: Yang D, Li L, Dong J, Yang W, Liu Z. Effects of continuous positive airway pressure on cardiac events and metabolic components in patients with moderate to severe obstructive sleep apnea and coronary artery disease: a meta-analysis. J Clin Sleep Med. 2023;19(12):2015-2025.

Keywords: continuous positive airway pressure; coronary artery disease; meta-analysis; obstructive sleep apnea.

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Conflict of interest statement

All authors have seen and approved this manuscript. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Flow diagram of the study selection process for meta-analysis.
Figure 2
Figure 2. Forest plot showing the effect of CPAP vs control on MACEs.
CI = confidence interval, CPAP = continuous positive airway pressure, MACE = major adverse cardiovascular endpoint, M-H = Mantel-Haenszel.
Figure 3
Figure 3. Forest plot showing the effect of CPAP vs control on all-cause death.
CI = confidence interval, CPAP = continuous positive airway pressure, M-H = Mantel-Haenszel.
Figure 4
Figure 4. Forest plot showing the effect of CPAP vs control on repeat revascularization.
CI = confidence interval, CPAP = continuous positive airway pressure, M-H = Mantel-Haenszel.
Figure 5
Figure 5. Forest plot showing the effect of CPAP vs control on ACS.
ACS = acute coronary syndrome, CI = confidence interval, CPAP = continuous positive airway pressure, M-H = Mantel-Haenszel.
Figure 6
Figure 6. Forest plot showing the effect of CPAP vs control on rehospitalization for heart failure.
CI = confidence interval, CPAP = continuous positive airway pressure, M-H = Mantel-Haenszel.
See this image and copyright information in PMC

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