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Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies

  • Sleep Breathing Physiology and Disorders • Review
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Abstract

Purpose

Recent studies have shown an association between obstructive sleep apnea (OSA) and coronary artery disease; however, the association between OSA and cardiac outcomes in patients after percutaneous coronary intervention (PCI) remains undetermined.

Methods

PubMed, EMBASE, and CENTRAL were searched from inception to July 2016 for cohort studies that followed up with patients after PCI, and evaluated their overnight sleep patterns within 1 month for major adverse cardiac events (MACEs) as primary outcomes including cardiac death, non-fatal myocardial infarction (MI), and coronary revascularization and secondary outcomes including re-admission for heart failure and stroke. Outcomes data were pooled using fixed-effect meta-analysis, and heterogeneity was assessed with the I 2 statistics. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale checklist, and publication bias was evaluated by a visual investigation of funnel plots.

Results

We identified seven pertinent studies including 2465 patients from 178 related articles. OSA was associated with MACEs (odds ratio [OR], 1.52, 95% confidence interval [CI], 1.20–1.93, I 2 = 29%), which included cardiac death (OR 2.05, 95% CI, 1.15–3.65, I 2 = 0%), non-fatal MI (OR 1.59, 95% CI, 1.14–2.23, I 2 = 15%), and coronary revascularization (OR 1.69, 95% CI, 1.28–2.23, I 2 = 0%). However, OSA was not associated with re-admission for heart failure (OR 1.71, 95% CI, 0.99–2.96, I 2 = 0%) and/or stroke (OR 1.68, 95% CI, 0.91–3.11, I 2 = 0%) according to the pooled results.

Conclusions

In patients after PCI, OSA appears to increase the risk of cardiac death, non-fatal MI, and coronary revascularization.

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Author information

Authors and Affiliations

  1. China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China

    Hua Qu, Ming Guo, Ying Zhang & Da-zhuo Shi

  2. Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China

    Hua Qu

  3. Xiyuan Hospital, China Academy of Traditional Chinese, Beijing, China

    Hua Qu, Ming Guo, Ying Zhang & Da-zhuo Shi

  4. Graduate School of China Academy of Chinese Medical Sciences, Beijing, China

    Ming Guo

Authors
  1. Hua Qu
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  2. Ming Guo
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  3. Ying Zhang
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  4. Da-zhuo Shi
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Contributions

Da-zhuo Shi designed the review and provided methodological perspectives; Hua Qu, Ming Guo, and Ying Zhang developed the search strategy and performed the literature search, study selection, data extraction, and data analyses. Hua Qu and Ming Guo contributed equally to this work and are co-first authors.

Corresponding author

Correspondence to Da-zhuo Shi.

Ethics declarations

Funding

This work was supported by the National Natural Science Foundation of China (no. 81030063).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not necessary for this meta-analysis, as only identified pooled data from previously approved individual studies was used.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Comment

The question of whether or not OSA increases the risk of adverse outcome after PCI is one which has been addressed by a large number of studies. In this meta-analysis the authors show increased adverse events after PCI in those with OSA. Translating this into clinical practice is clearly of interest and with that in mind it is interesting to compare and contrast the approach of Cardiologists to defining procedural success in PCI in both stable and unstable coronary disease with the limited diagnostic and therapeutic success in sleep apnea. Simplified diagnostic methods are being incorporated into clinical pathways in OSA assessment but the greatest weakness remains adherence and efficacy monitoring which will be needed to change practice amongst Cardiologists used to more rigorous approaches to diagnosis and treatment.

Ian Wilcox

Sydney, Australia

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Qu, H., Guo, M., Zhang, Y. et al. Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies. Sleep Breath 22, 33–40 (2018). https://doi.org/10.1007/s11325-017-1503-8

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  • DOI: https://doi.org/10.1007/s11325-017-1503-8

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