Impact of Continuous Positive Airway Pressure on Cardiovascular Health in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Abstract

Obstructive sleep apnea (OSA) is a growing health concern affecting nearly 1 billion people worldwide. Untreated OSA heightens the risk of cardiovascular (CV) complications. This meta-analysis aims to evaluate the effectiveness of continuous positive airway pressure (CPAP) in preventing adverse CV outcomes as compared with placebo or standard care in OSA patient Google Scholar, PubMed and Scopus databases were systematically searched from inception until March 2023. The outcomes of interest were major adverse CV events (MACE), all-cause mortality, CV mortality, stroke, unstable angina, new-onset atrial fibrillation (AF), myocardial infarction (MI), and hospitalization for heart failure (HF). A total of 9 361 participants from 9 randomized controlled trials and 6 observational studies were included in the analysis. Our meta-analysis reports that CPAP significantly reduces the risk of MACE [risk ratio (RR) = 0.69, 95% confidence interval (CI): 0.54-0.89] and CV mortality (RR = 0.53, 95% CI: 0.30-0.91) as compared with placebo or standard care in OSA patients. However, CPAP therapy did not show significant effects on specific CV conditions; unstable angina (RR = 1.20, 95% CI: 0.67-2.15), acute MI (RR = 0.95, 95% CI: 0.73-1.24), new-onset AF (RR = 0.89, 95% CI: 0.50-1.58), hospitalization for HF (RR = 0.83, 95% CI: 0.60-1.15), and stroke (RR = 0.89, 95% CI: 0.70-1.14). CPAP therapy significantly improves the MACE and CV mortality as compared with placebo or standard care in patients with OSA. However, no significant association was seen between CPAP and other CV outcomes, including unstable angina, MI, AF, HF hospitalization, and stroke.

Keywords: MACE; cardiovascular mortality; continuous positive airway pressure; obstructive sleep apnea.