Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials
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Obstructive sleep apnea (OSA) is associated with increased levels of systemic inflammatory markers, increased arterial stiffness, and endothelial dysfunction, which may lead to increased cardiovascular risk. We aimed to quantify the effects of continuous positive airway pressure (CPAP) on cardiovascular biomarkers and to establish predictors of response to CPAP.
We searched PubMed and the Cochrane Library from inception to May 31, 2017. Randomized controlled trials (RCTs) assessing the efficacy of CPAP on high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor- alpha (TNF-α), augmentation index (AIx), pulse wave velocity (PWV), and flow-mediated dilatation (FMD) in patients with OSA were selected by consensus.
We included 15 RCTs comprising 1090 patients in the meta-analysis. The pooled standard mean difference (SMD) of effect of CPAP on hs-CRP was − 0.64 (95% confidence interval (CI) − 1.19 to − 0.09; P = 0.02). CPAP was associated with a reduction in AIx of 1.53% (95% CI, 0.80 to 2.26%; P < 0.001) and a significant increase in FMD of 3.96% (95% CI 1.34 to 6.59%; P = 0.003). Subgroup analyses found CPAP was likely to be more effective in improving FMD levels in severe OSA patients or patients with effective CPAP use ≥ 4 h/night.
Among patients with OSA, CPAP improves inflammatory marker hs-CRP, arterial stiffness marker AIx, and endothelial function marker FMD. These biomarkers may provide information related to response to treatment. Future studies will need to clarify the efficacy of these biomarkers in assessing cardiovascular risk reduction among OSA treated with CPAP.
KeywordsContinuous positive airway pressure Cardiovascular biomarker Obstructive sleep apnea Meta-analysis
Drs. Y.N., M.Z., and Y.X.W. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Y.N., M.Z., T.S.Z., and Y.X.W. conceived and designed the study. Y.N. and T.S.Z. reviewed the scientific literature, did the statistical analysis, prepared all tables and figures, and wrote the first draft of the report. Y.N., T.S.Z., and W.W.W. contributed to acquisition of data and quality assessment. M.Z. and Y.X.W. reviewed and revised the article. All authors made a critical revision of the manuscript for key intellectual content.
This work was supported by International Science & Technology Cooperation Program of China (2015DFA30160); Beijing Municipal Science & Technology Commission (Z141100006014057); Beijing Key Laboratory of upper airway dysfunction related cardiovascular diseases (BZ0377); Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201605); Beijing Medical Project 2016-4; and Beijing Municipal Training Foundation for Highly-qualified and Technological Talents of Health System (2014-3-038).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval was not necessary for this meta-analysis, as only identified pooled data from previously approved individual studies was used.
Informed consent was obtained from all individual participants included in the study.
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