Continuous positive airway pressure (CPAP) therapy did not significantly reduce the risk of recurrent major adverse cardiac or cerebral events (OR 0.94) compared to usual care in patients with obstructive sleep apnoea and established cardiovascular disease.
Meta-Analysis (n=4,493)
Does continuous positive airway pressure (CPAP) therapy reduce major adverse cardiac or cerebral events (MACCEs) in patients with moderate to severe obstructive sleep apnoea and previous cardiovascular or cerebrovascular diseases?
CPAP therapy does not significantly reduce recurrent major adverse cardiovascular events in patients with OSA and established cardiovascular disease, though adherence >4 hours/night may offer benefits for CV mortality and stroke.
Effect estimate: OR 0.94 (95% CI 0.79-1.12)
p-value: p=0.5
Background: 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. Methods: 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. Result: 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, p = 0.5, CV mortality (OR 0.83, 95% CI 0.54–1.26, p = 0.37), myocardial infarction (OR 1.09, 95% CI 0.8–1.47, p = 0.6), heart failure (OR 0.94, 95% CI 0.66–1.33, p = 0.71), stroke (OR 0.9, 95% CI 0.67–1.23, p = 0.52), or all-cause death (OR 0.86, 95% CI 0.63–1.16, p = 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, p = 0.02) and stoke (OR 0.39, 95% CI 0.15–0.97, p = 0.04) in patients who used it more than 4 hours. Conclusions: 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. The correlation between CPAP and the prognosis of OSA patients warrants further study.
Li et al. (Fri,) conducted a meta-analysis in Obstructive sleep apnoea with previous cardiovascular or cerebrovascular disease (n=4,493). Continuous positive airway pressure (CPAP) vs. Usual care was evaluated on Major adverse cardiac or cerebral events (MACCEs) (OR 0.94, 95% CI 0.79-1.12, p=0.5). Continuous positive airway pressure (CPAP) therapy did not significantly reduce the risk of recurrent major adverse cardiac or cerebral events (OR 0.94) compared to usual care in patients with obstructive sleep apnoea and established cardiovascular disease.
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