持续气道正压通气治疗对阻塞性睡眠呼吸暂停患者的心血管影响:一项荟萃分析。
Cardiovascular Effects of Continuous Positive Airway Pressure Treatment in Patients With Obstructive Sleep Apnea: A Meta-Analysis.
作者信息
Aslan Gamze, Afsar Baris, Siriopol Dimitrie, Kanbay Asiye, Sal Oguzhan, Benli Caghan, Okcuoglu John, Covic Adrian, Kanbay Mehmet
机构信息
1 Department of Cardiology, Koc University Hospital, Istanbul, Turkey.
2 Department of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey.
出版信息
Angiology. 2018 Mar;69(3):195-204. doi: 10.1177/0003319717709175. Epub 2017 May 16.
Continuous positive airway pressure (CPAP) is the first-line treatment of obstructive sleep apnea (OSA). Obstructive sleep apnea is a predictor of cardiovascular (CV) events. In this meta-analysis, we evaluated the effect of CPAP on left ventricular ejection fraction (LVEF), CV events, CV mortality, and all-cause mortality in patients with OSA. Nine articles (n = 9610 patients) were analyzed. Four different meta-analyses were performed: evaluation of LVEF, assessment of all-cause mortality, CV mortality, and CV events. Continuous positive airway pressure treatment was associated with a significant increase in LVEF (mean difference: 2.1%, 95% confidence interval [CI]: 0.8%-3.4%). There was a nonsignificant reduction in all-cause mortality (hazard ratio [HR]: 0.92, 95% CI: 0.73-1.15) but a significant reduction of 66% in the risk of CV mortality associated with the CPAP treatment (HR: 0.34, 95% CI: 0.17-0.68, P = .002). There was a nonsignificant reduction in the risk of CV events in the CPAP-treated patients (HR: 0.84, 95% CI: 0.60-1.18, P = .31). Our meta-analyses showed that CPAP treatment improves LVEF and could have a beneficial effect on CV mortality.
持续气道正压通气(CPAP)是阻塞性睡眠呼吸暂停(OSA)的一线治疗方法。阻塞性睡眠呼吸暂停是心血管(CV)事件的一个预测指标。在这项荟萃分析中,我们评估了CPAP对OSA患者左心室射血分数(LVEF)、CV事件、CV死亡率和全因死亡率的影响。分析了9篇文章(n = 9610例患者)。进行了四项不同的荟萃分析:LVEF评估、全因死亡率评估、CV死亡率评估和CV事件评估。持续气道正压通气治疗与LVEF显著增加相关(平均差异:2.1%,95%置信区间[CI]:0.8%-3.4%)。全因死亡率有非显著降低(风险比[HR]:0.92,95%CI:0.73-1.15),但与CPAP治疗相关的CV死亡率风险显著降低66%(HR:0.34,95%CI:0.17-0.68,P = .002)。接受CPAP治疗的患者发生CV事件的风险有非显著降低(HR:0.84,95%CI:0.60-1.18,P = .31)。我们的荟萃分析表明,CPAP治疗可改善LVEF,并可能对CV死亡率产生有益影响。