Swami Shivling S, Aye Soe Lwin, Trivedi Yash, Bolgarina Zoryana, Desai Heet N, Senaratne Mithum, Mohammed Lubna
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2023 Sep 12;15(9):e45076. doi: 10.7759/cureus.45076. eCollection 2023 Sep.
Increased cardiovascular (CV) morbidity and death are linked to obstructive sleep apnoea (OSA). The primary method of treating OSA is continuous positive airway pressure (CPAP). CPAP has some debatable outcomes on CV events in people suffering from OSA. The current study investigates how CPAP affects CV outcomes. The goal is to evaluate CPAP's effectiveness in lowering CV outcomes in OSA patients. We used a computer to search the PubMed, PubMed Central Library, Science Direct, and Google Scholar databases for studies comparing the effects of CPAP and a control group on CV outcomes in OSA patients. These included randomised control trials (RCT), narrative reviews, systematic reviews, case-control studies, observational studies and meta-analyses. A total of 52,937 patients were included in the final analysis of six RCTs, four observational studies, 10 meta-analyses, one case-control study, two systematic reviews and one narrative review. The weighted mean follow-up lasted for a period of between three months and nine years. The risk of major cardiovascular adverse events (MACE) was the same for both the CPAP and control groups. According to subgroup analysis, patients with lower MACE adherence rates (four hours per night) were more likely to use CPAP. The risk of all-cause mortality, CV-related complications causing mortality, acute myocardial infarction acute stroke, or hospitalisations for angina was the same in the CPAP and control groups. The primary outcome was that in patients with therapy with CPAP in addition to usual care and usual care alone did not prevent CV events in patients with moderate-to-severe OSA and existing CV illness. Patients with OSA who utilise CPAP may not experience fewer CV events. Patients who use CPAP consistently (four hours per night) could benefit from improved CV results. Future research must assess how well-adherent patients with severe OSA and low CV event rates respond to CPAP therapy. In patients who use CPAP for more than four hours each night, CPAP therapy may minimise the risk of MACE and stroke. Additional randomised trials requiring adequate CPAP time adherence are needed to support this perception. Despite the fact that there is no evidence to support the claim that CPAP therapy improves CV outcomes, bias difficulties, CPAP adherence problems, and the patient groups included in each RCT may have made it more difficult to generalise the findings to all patients. Future research is therefore needed to look at these relevant results.
心血管（CV）发病率和死亡率的增加与阻塞性睡眠呼吸暂停（OSA）有关。治疗OSA的主要方法是持续气道正压通气（CPAP）。CPAP对OSA患者的心血管事件有一些有争议的结果。当前的研究调查了CPAP如何影响心血管结局。目标是评估CPAP在降低OSA患者心血管结局方面的有效性。我们使用计算机在PubMed、PubMed中央图书馆、Science Direct和谷歌学术数据库中搜索比较CPAP与对照组对OSA患者心血管结局影响的研究。这些研究包括随机对照试验（RCT）、叙述性综述、系统评价、病例对照研究、观察性研究和荟萃分析。六项RCT、四项观察性研究、十项荟萃分析、一项病例对照研究、两项系统评价和一项叙述性综述的最终分析共纳入52937名患者。加权平均随访持续时间为三个月至九年。CPAP组和对照组发生主要心血管不良事件（MACE）的风险相同。根据亚组分析，MACE依从率较低（每晚四小时）的患者更有可能使用CPAP。CPAP组和对照组在全因死亡率、导致死亡的心血管相关并发症、急性心肌梗死、急性中风或因心绞痛住院方面的风险相同。主要结果是，在中度至重度OSA和现有心血管疾病患者中，除常规护理外接受CPAP治疗的患者与仅接受常规护理的患者相比，并未预防心血管事件。使用CPAP的OSA患者可能不会经历更少的心血管事件。持续使用CPAP（每晚四小时）的患者可能会从改善的心血管结果中受益。未来的研究必须评估严重OSA且心血管事件发生率低的依从性良好的患者对CPAP治疗的反应情况。在每晚使用CPAP超过四小时的患者中，CPAP治疗可能会降低MACE和中风的风险。需要更多要求足够CPAP时间依从性的随机试验来支持这一观点。尽管没有证据支持CPAP治疗可改善心血管结局的说法，但偏倚问题、CPAP依从性问题以及每个RCT中纳入的患者群体可能使将研究结果推广到所有患者变得更加困难。因此，未来的研究需要关注这些相关结果。
