Li Huan, Pan Yueyang, Lou Yake, Zhang Yujie, Yin Leran, Sanderson John E, Fang Fang
Department of Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, 100029 Beijing, China.
Princeton International School of Mathematics and Science, Princeton, NJ 08540, USA.
Rev Cardiovasc Med. 2022 May 27;23(6):195. doi: 10.31083/j.rcm2306195. eCollection 2022 Jun.
Obstructive sleep apnoea (OSA) is highly prevalent and significantly associated with major adverse cardiovascular events (MACEs). Continuous positive airway pressure (CPAP) treatment has a protective effect on cardiovascular events in OSA patients. However, whether CPAP therapy significant reduces the risk of recurrent cardiovascular (CV) events in OSA patients with established cardiovascular or cerebrovascular diseases remains disputed. We aim to evaluate the effect of CPAP on recurrent cardiovascular outcomes in moderate to severe OSA patients with previous cardiovascular or cerebrovascular diseases.
We searched the electronic databases (PubMed, EMBASE, and Cochrane library) from their inception to August, 2021. Only randomized controlled trials (RCTs) that described the association of CPAP treatment in patients with cardiovascular or cerebrovascular disease and OSA were included in our analysis. The primary outcome of interest was major adverse cardiac or cerebral events (MACCEs), a composite endpoint of myocardial infraction (MI), non-fatal stroke, CV mortality; secondary outcomes included all-caused death, cardiac mortality, myocardial infraction, atrial fibrillation, heart failure, repeat revascularization, angina, stroke, and transient ischemic attack. In addition, subgroup analyses based on CPAP adherence were performed.
Six RCTs of 4493 participants were included in the analysis. Compared with usual care, CPAP therapy did not significantly reduce the risk of recurrent MACCEs odds ratio (OR) 0.94, 95% confidence interval (CI) 0.79-1.12, = 0.5, CV mortality (OR 0.83, 95% CI [0.54-1.26], = 0.37), myocardial infarction (OR 1.09, 95% CI [0.8-1.47], = 0.6), heart failure (OR 0.94, 95% CI [0.66-1.33], = 0.71), stroke (OR 0.9, 95% CI [0.67-1.23], = 0.52), or all-cause death (OR 0.86, 95% CI [0.63-1.16], = 0.32). However, the subgroup analyses revealed that CPAP can decrease the risk of CV mortality (OR 0.25, 95% CI [0.08-0.77], = 0.02) and stoke (OR 0.39, 95% CI [0.15-0.97], = 0.04) in patients who used it more than 4 hours.
CPAP therapy was not associated with reduce the risk of MACCEs in OSA patients with a history of chronic cardiovascular disease who utilize CPAP 4 hours/night, although CPAP appeared to have a positive effect on CV mortality and stroke among those who used CPAP 4 hours. The correlation between CPAP and the prognosis of OSA patients warrants further study.
阻塞性睡眠呼吸暂停（OSA）非常普遍，且与主要不良心血管事件（MACEs）显著相关。持续气道正压通气（CPAP）治疗对OSA患者的心血管事件具有保护作用。然而，CPAP治疗是否能显著降低已患有心血管或脑血管疾病的OSA患者复发性心血管（CV）事件的风险仍存在争议。我们旨在评估CPAP对既往有心血管或脑血管疾病的中重度OSA患者复发性心血管结局的影响。
我们检索了电子数据库（PubMed、EMBASE和Cochrane图书馆）自建库至2021年8月的文献。我们的分析仅纳入了描述CPAP治疗与心血管或脑血管疾病及OSA患者之间关联的随机对照试验（RCT）。感兴趣的主要结局是主要不良心脏或脑部事件（MACCEs），这是一个包括心肌梗死（MI）、非致命性中风、心血管死亡率的复合终点；次要结局包括全因死亡、心脏死亡率、心肌梗死、心房颤动、心力衰竭、再次血管重建、心绞痛、中风和短暂性脑缺血发作。此外，还进行了基于CPAP依从性的亚组分析。
分析纳入了6项随机对照试验，共4493名参与者。与常规治疗相比，CPAP治疗并未显著降低复发性MACCEs的风险（比值比[OR]为0.94，95%置信区间[CI]为0.79 - 1.12，P = 0.5）、心血管死亡率（OR为0.83，95% CI [0.54 - 1.26]，P = 0.37）、心肌梗死（OR为1.09，95% CI [0.8 - 1.47]，P = 0.6）、心力衰竭（OR为0.94，95% CI [0.66 - 1.33]，P = 0.71）、中风（OR为0.9，95% CI [0.67 - 1.23]，P = 0.52）或全因死亡（OR为0.86，95% CI [0.63 - 1.16]，P = 0.32）。然而，亚组分析显示，在使用CPAP超过4小时的患者中，CPAP可降低心血管死亡率（OR为0.25，95% CI [0.08 - 0.77]，P = 0.02）和中风（OR为0.39，95% CI [0.15 - 0.97]，P = 0.04）的风险。
对于每晚使用CPAP不足4小时且有慢性心血管疾病史的OSA患者，CPAP治疗与降低MACCEs风险无关，尽管CPAP似乎对使用CPAP超过4小时的患者的心血管死亡率和中风有积极影响。CPAP与OSA患者预后之间的相关性值得进一步研究。
