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Effect of CPAP therapy on cardiovascular events and mortality in patients with obstructive sleep apnea: a meta-analysis

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Continuous positive airway pressure (CPAP) therapy may decrease the risk of mortality and cardiovascular events in patients with obstructive sleep apnea. However, these benefits are not completely clear.

Methods

We undertook a meta-analysis of randomized clinical trials identified in systematic searches of MEDLINE, EMBASE, and the Cochrane Database.

Results

Eighteen studies (4146 patients) were included. Overall, CPAP therapy did not significantly decrease the risk of cardiovascular events compared with the control group (odds ratio (OR), 0.84; 95 % confidence intervals (CI), 0.62–1.13; p = 0.25; I 2 = 0 %). CPAP was associated with a nonsignificant trend of lower rate of death and stroke (for death: OR, 0.85; 95 % CI, 0.35–2.06; p = 0.72; I 2 = 0.0 %; for stroke: OR, 0.56; 95 % CI, 0.18–1.73; p = 0.32; I 2 = 12.0 %), a significantly lower Epworth sleepiness score (ESS) (mean difference (MD), −1.78; 95 % CI, −2.31 to −1.24; p < 0.00001; I 2 = 76 %), and a significantly lower 24 h systolic and diastolic blood pressure (BP) (for 24 h systolic BP: MD, −2.03 mmHg; 95 % CI, −3.64 to −0.42; p = 0.01; I 2 = 0 %; for diastolic BP: MD, −1.79 mmHg; 95 % CI, −2.89 to −0.68; p = 0.001; I 2 = 0 %). Daytime systolic BP and body mass index were comparable between the CPAP and control groups. Subgroup analysis did not show any significant difference between short- and mediate-to-long-term follow-up groups with regard to cardiovascular events, death, and stroke.

Conclusions

CPAP therapy was associated with a trend of decreased risk of cardiovascular events. Furthermore, ESS and BP were significantly lower in the CPAP group. Larger randomized studies are needed to confirm these findings.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in an organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Our study was a meta-analysis of clinical studies that have been published, so the informed consent from all individual participants included in all 18 studies are not necessary.

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China

    Jun Guo

  2. Department of Cardiology, Binzhou City Center Hospital, No. 208, Huimin South Road, Binzhou, Shandong, China

    Yu Sun, Yong-Shen Wang, Lei Zhang, Gui-Hua Zhou & Li-Xin Yuan

  3. Department of Cardiology, Second Affiliated Hospital and Second Clinical Medical College, Fujian Medical University, Quanzhou, Fujian, China

    Yu Sun & Zi-Yang Huang

  4. Department of Neonatology, Shenzhen Bao’an District Songgang People’s Hospital, Shenzhen, Guangdong, China

    Li-Jun Xue

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  1. Jun Guo
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Corresponding author

Correspondence to Yu Sun.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Jun Guo and Li-Jun Xue contributed equally to this article and should be considered as co-first authors.

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Guo, J., Sun, Y., Xue, LJ. et al. Effect of CPAP therapy on cardiovascular events and mortality in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 20, 965–974 (2016). https://doi.org/10.1007/s11325-016-1319-y

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  • DOI: https://doi.org/10.1007/s11325-016-1319-y

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