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Meta-analysis of all-cause and cardiovascular mortality in obstructive sleep apnea with or without continuous positive airway pressure treatment

Abstract

Purpose

The associations between obstructive sleep apnea (OSA) and all-cause and cardiovascular mortality are well established but are not entirely consistent. To accurately evaluate these associations as well as the therapeutic effects of continuous positive airway pressure (CPAP), we conducted a comprehensive meta-analysis of all eligible cohort studies.

Methods

Electronic literature databases (i.e., PubMed and Embase) were searched for relevant studies published before January 2016 that evaluated the associations between OSA and all-cause or cardiovascular mortality. Random-effect models were used to calculate the pooled hazard ratio (HR) and corresponding 95 % confidence intervals (CIs) for categorical risk estimates. The therapeutic effects of CPAP treatment for all-cause and cardiovascular mortality in OSA were examined through the meta-analysis.

Results

The 27 cohort studies included in the meta-analysis included 3,162,083 participants. Compared to the control group, the pooled HR of all-cause mortality was 1.19 (95 % CI, 0.86–1.65) for mild OSA, 1.28 (0.96–1.69) for moderate OSA, and 2.13 (1.68–2.68) for severe OSA. The pooled HR of cardiovascular mortality was 1.24 (0.53–2.55) for mild OSA, 2.05 (0.57–5.47) for moderate OSA, and 2.73 (1.94–3.85) for severe OSA. All-cause mortality (HR 0.66; 0.59–0.73) and cardiovascular mortality (HR 0.37; 0.16–0.54) were significantly lower in CPAP-treated than in untreated patients. There were no differences in cardiovascular mortality in CPAP-treated OSA patients vs. normal control subjects (HR 0.82; 0.52–1.29).

Conclusions

Greater attention should be paid to severe OSA, as it is an independent predictor for risk for all-cause and cardiovascular mortality. CPAP is an effective treatment that reduces risk of mortality.

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Correspondence to Huajun Xu or Jian Guan.

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Funding

This study was supported by grants-in-aid from multi-center clinical research project from school of medicine, Shanghai Jiao Tong University (DLY201502), and Shanghai Shen-Kang Hospital Management Center Project of Shanghai (SHDC12015101).

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

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

Informed consent

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

Additional information

Yiqun Fu and Yunyan Xia contributed equally to this work.

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Fu, Y., Xia, Y., Yi, H. et al. Meta-analysis of all-cause and cardiovascular mortality in obstructive sleep apnea with or without continuous positive airway pressure treatment. Sleep Breath 21, 181–189 (2017). https://doi.org/10.1007/s11325-016-1393-1

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  • DOI: https://doi.org/10.1007/s11325-016-1393-1

Keywords

  • Obstructive sleep apnea
  • All-cause mortality
  • Cardiovascular mortality
  • Meta-analysis