Department of Internal Medicine, Howard University Hospital, Washington DC.
Department of Internal Medicine, Howard University Hospital, Washington DC.
Curr Probl Cardiol. 2024 Jan;49(1 Pt C):102139. doi: 10.1016/j.cpcardiol.2023.102139. Epub 2023 Oct 18.
The association between untreated obstructive sleep apnea (OSA) and cardiovascular disease (CVD) is well known. In this literature review, we aim to review the existing literature on treatment effects of OSA and its impact on CVD morbidity and mortality, stratified by gender. We systematically reviewed PubMed, Medline, and Scopus per PRISMA guidelines and included 25 studies in the final review. Primary outcomes were CVD-associated morbidity and mortality. Out of 25 studies, 10 were meta-analysis, 8 observational, and 7 randomized controlled trials. The treatment modality was continuous positive airway pressure (CPAP) in 23 studies, noninvasive positive pressure ventilation, and oral appliance therapy in 2. Secondary prevention of CVD was the endpoint in 23 studies. A total of 165,775 participants between 45 and 75 years of age, 60%-90% males, and the average Epworth Sleepiness Scale (ESS) score was 5-9. CV outcomes included myocardial infarction, angina, heart failure (HF), acute coronary syndrome (ACS), coronary artery disease (CAD), ischemic heart disease, cardiomyopathy, atrial fibrillation (AF), and hypertension. In 4 studies, CPAP was associated with a reduction in CVD mortality, and 10 studies showed improvement in morbidity. Our review of literature did not show consistent benefits in CV outcomes in OSA patients. We identified many potential research areas, especially the lack of studies demonstrating dose-dependent effect of OSA treatment on CV outcomes, especially when stratified by severity of OSA and gender. Larger prospective studies with longer follow-up will be helpful to study these parameters.
未经治疗的阻塞性睡眠呼吸暂停(OSA)与心血管疾病(CVD)之间的关联是众所周知的。在本文献综述中,我们旨在回顾现有的关于 OSA 治疗效果及其对 CVD 发病率和死亡率影响的文献,按性别进行分层。我们按照 PRISMA 指南系统地检索了 PubMed、Medline 和 Scopus,并将 25 项研究纳入最终综述。主要结局是与 CVD 相关的发病率和死亡率。在 25 项研究中,有 10 项是荟萃分析,8 项是观察性研究,7 项是随机对照试验。治疗方式为持续气道正压通气(CPAP)的有 23 项研究,无创正压通气和口腔矫治器治疗的各有 2 项。23 项研究的二级预防终点为 CVD。共有 165775 名年龄在 45-75 岁之间、60%-90%为男性、平均 Epworth 睡眠量表(ESS)评分为 5-9 的参与者。心血管结局包括心肌梗死、心绞痛、心力衰竭(HF)、急性冠状动脉综合征(ACS)、冠状动脉疾病(CAD)、缺血性心脏病、心肌病、心房颤动(AF)和高血压。在 4 项研究中,CPAP 与 CVD 死亡率降低相关,10 项研究显示发病率改善。我们对文献的综述并未显示 OSA 患者的心血管结局有一致的获益。我们确定了许多潜在的研究领域,特别是缺乏研究表明 OSA 治疗对心血管结局的剂量依赖性影响,尤其是当按 OSA 严重程度和性别分层时。更大规模的前瞻性研究和更长时间的随访将有助于研究这些参数。