Association between obstructive sleep apnoea syndrome and the risk of cardiovascular diseases: an updated systematic review and dose-response meta-analysis.

OBJECTIVE

The aim of this study was to summarize the evidence concerning the relationship between obstructive sleep apnoea syndrome (OSAS) and the risk of cardiovascular diseases (CVDs).

METHODS

A systematic search was carried out using PubMed and Web of Science up to September 10, 2019. Categorical as well as linear and non-linear dose-response meta-analyses were respectively performed to evaluate the association between the severity of OSAS and the risk of CVDs. Apnoea-hypopnea index (AHI) was used as an indicator of OSAS severity.

RESULTS

This study included 10 cohort studies targeting a total of 36,347 subjects and 3362 patients with CVDs. The pooled RRs of overall CVDs were 1.13 (95% confidence interval [CI] = 1.02-1.24) for mild versus non/normal OSAS, 1.16 (95% CI = 1.02-1.32) for moderate versus non/normal OSAS, 1.26 (95% CI = 1.15-1.39) for moderate-severe versus non/normal OSAS, and 1.41 (95% CI = 1.22-1.63) for severe versus non/normal OSAS. The linear dose-response meta-analysis showed that every 10 events/hour increment in AHI value was associated with a 9% increased risk of suffering from CVDs. The non-linear dose-response meta-analysis showed that the risk of CVDs increased continuously with the increment in AHI.

CONCLUSION

The present systematic review and meta-analysis provide evidence for a positive association between OSAS and the risk of CVDs, despite the severity of OSAS. The relative risk of CVDs increases continuously with the increment in AHI.