Skip to main content
SpringerLink
Log in

Effect of continuous positive pressure ventilation on left ventricular diastolic function E/A ratio in patients with obstructive sleep apnea: a meta-analysis

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Many studies have shown that obstructive sleep apnea (OSA) is related to reduced left ventricular diastolic function. Continuous positive airway pressure (CPAP) is generally recognized as the preferred therapy for OSA. Yet, the effect of CPAP on left ventricular diastolic function in patients with OSA is inconclusive. In order to assess the influence of CPAP on left ventricular diastolic function in patients with OSA, we performed this meta-analysis of clinical experiments.

Methods

PubMed, Web of Science, OVID, Embase, and Cochrane Library from the establishment of the database to July 6, 2022, were searched for clinical trial data. Inclusion criteria for this meta-analysis were: (1) Patients in the experimental group were diagnosed with OSA by polysomnography; (2) CPAP treatment course ≥ 4 weeks; (3) baseline and follow-up data of the diastolic function parameter E/A ratio were reported in the literature. Exclusion criteria were: (1) Central sleep apnea (CSA); (2) comorbid organic heart diseases such as coronary heart disease; (3) age < 18 years old; (4) conference abstracts or duplicate publications.

Results

After exclusions, 7 studies (2 RCTs and 5 prospective studies) with 473 subjects (225 in the treatment group and 248 in the matched control group) were included in the meta-analysis. Subgroup analysis indicated that after CPAP therapy, the left ventricular (LV) E/A ratio was significantly increased in patients with OSA (weighted mean difference (WMD) = 0.22, 95% CI =  − 0.06–0.38; P = 0.007). Sensitivity analyses showed that the combined results were not influenced by single studies. Publication bias was not significant (Egger’s test, P = 0.813).

Conclusions

The results of this meta-analysis suggest that CPAP may improve the E/A ratio in patients with OSA patients. However, the small number of studies (n = 7) decreases confidence in the findings. Thus, carefully designed randomized controlled trials are needed to confirm the findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

References

  1. Patel SR (2019) Obstructive sleep apnea. Ann Intern Med 171:ITC81-ITC96. https://doi.org/10.7326/AITC201912030

  2. Heinzer R et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318. https://doi.org/10.1016/s2213-2600(15)00043-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Peppard PE et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014. https://doi.org/10.1093/aje/kws342

    Article  PubMed  PubMed Central  Google Scholar 

  4. Javaheri S et al (2017) Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol 69:841–858. https://doi.org/10.1016/j.jacc.2016.11.069

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bauters FA et al (2019) Phenotype and risk burden of sleep apnea: a population-based cohort study. Hypertension 74:1052–1062. https://doi.org/10.1161/HYPERTENSIONAHA.119.13452

    Article  CAS  PubMed  Google Scholar 

  6. Akyol S et al (2016) Biventricular myocardial performance is impaired in proportion to severity of obstructive sleep apnea. Tex Heart Inst J 43:119–125. https://doi.org/10.14503/THIJ-14-4868

    Article  PubMed  PubMed Central  Google Scholar 

  7. D’Andrea A et al (2020) Subclinical impairment of dynamic left ventricular systolic and diastolic function in patients with obstructive sleep apnea and preserved left ventricular ejection fraction. BMC Pulm Med 20:76. https://doi.org/10.1186/s12890-020-1099-9

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peker Y, Thunström E, Glantz H, Eulenburg C (2020) Effect of obstructive sleep apnea and CPAP treatment on cardiovascular outcomes in acute coronary syndrome in the RICCADSA trial. J Clin Med 9:1–12. https://doi.org/10.3390/jcm9124051

    Article  CAS  Google Scholar 

  9. Yeghiazarians Y et al (2021) Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 144:e56–e67. https://doi.org/10.1161/CIR.0000000000000988

    Article  CAS  PubMed  Google Scholar 

  10. Silbiger JJ (2019) Pathophysiology and echocardiographic diagnosis of left ventricular diastolic dysfunction. J Am Soc Echocardiogr 32(216–232):212. https://doi.org/10.1016/j.echo.2018.11.011

    Article  Google Scholar 

  11. Zile MR, Brutsaert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 105:1387–1393. https://doi.org/10.1161/hc1102.105289

    Article  PubMed  Google Scholar 

  12. Bussoni MF et al (2014) Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure. Clinics 69:354–359. https://doi.org/10.6061/clinics/2014(05)010

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bilge AR et al (2014) The effect of long-term continuous positive airway pressure treatment on systolic and diastolic function in patients with obstructive sleep apnoea syndrome: a five year observational study. Anatol J Cardiol 14:265–271. https://doi.org/10.5152/akd.2014.4870

    Article  Google Scholar 

  14. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. Group, P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–269):W264. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

    Article  Google Scholar 

  15. Craig S et al (2015) Effect of CPAP on cardiac function in minimally symptomatic patients with OSA: results from a subset of the MOSAIC randomized trial. J Clin Sleep Med 11:967–973. https://doi.org/10.5664/jcsm.5004

    Article  PubMed  PubMed Central  Google Scholar 

  16. Banares R et al (2002) Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 35:609–615. https://doi.org/10.1053/jhep.2002.31354

    Article  PubMed  Google Scholar 

  17. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al (2008) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2007. URL: http://www.ohrica/programs/clinicalepidemiology/oxford.htm

  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  19. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101

    Article  CAS  PubMed  Google Scholar 

  20. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Oliveira W et al (2009) Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography. Heart (British Cardiac Society) 95:1872–1878. https://doi.org/10.1136/hrt.2009.173625

    Article  CAS  PubMed  Google Scholar 

  22. ChunMei M, HuiLiang L, Wei H, JianPing L, DeJing J (2008) Effects of nasal continuous positive airway pressure on left ventricular structure and diastolic function in patients with obstructive sleep apnoea syndrome. J Fourth Military Med Univ 29:1593–1596

    Google Scholar 

  23. Li J-R et al (2018) Early cardiac injury in patients with obstructive sleep apnea Zhongguo ying yong sheng li xue za zhi = Zhongguo yingyong shenglixue zazhi. Chi J Appl Physiol 34:457–461. https://doi.org/10.12047/j.cjap.5707.2018.103

    Article  Google Scholar 

  24. Butt M, Dwivedi G, Shantsila A, Khair OA, Lip GYH (2012) Left ventricular systolic and diastolic function in obstructive sleep apnea impact of continuous positive airway pressure therapy. CIRCULATION-HEART FAILURE 5:226–233. https://doi.org/10.1161/CIRCHEARTFAILURE.111.964106

    Article  PubMed  Google Scholar 

  25. Bayram NA et al (2009) Effects of continuous positive airway pressure therapy on left ventricular function assessed by tissue Doppler imaging in patients with obstructive sleep apnoea syndrome. Eur J Echocardiogr 10:376–382. https://doi.org/10.1093/ejechocard/jen257

    Article  Google Scholar 

  26. Alchanatis M, Paradellis G, Pini H, Tourkohoriti G, Jordanoglou J (2000) Left ventricular function in patients with obstructive sleep apnoea syndrome before and after treatment with nasal continuous positive airway pressure. Respiration 67:367–371. https://doi.org/10.1159/000029532

    Article  CAS  PubMed  Google Scholar 

  27. Arias MA et al (2005) Obstructive sleep apnea syndrome affects left ventricular diastolic function - effects of nasal continuous positive airway pressure in men. Circulation 112:375–383. https://doi.org/10.1161/circulationaha.104.501841

    Article  PubMed  Google Scholar 

  28. Hammerstingl C et al (2013) Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy. PLoS One 8:76352. https://doi.org/10.1371/journal.pone.0076352

    Article  CAS  Google Scholar 

  29. Johnson CB et al (2008) Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure. Can J Cardiol 24:697–704. https://doi.org/10.1016/s0828-282x(08)70668-8

    Article  PubMed  PubMed Central  Google Scholar 

  30. Oliveira W et al (2009) Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography. Heart 95:1872–1878. https://doi.org/10.1136/hrt.2009.173625

    Article  CAS  PubMed  Google Scholar 

  31. Yu L et al (2020) Left ventricular remodeling and dysfunction in obstructive sleep apnea : systematic review and meta-analysis. Herz 45:726–738. https://doi.org/10.1007/s00059-019-04850-w

    Article  PubMed  Google Scholar 

  32. Bradley TD, Hall MJ, Ando S, Floras JS (2001) Hemodynamic effects of simulated obstructive apneas in humans with and without heart failure. Chest 119:1827–1835. https://doi.org/10.1378/chest.119.6.1827

    Article  CAS  PubMed  Google Scholar 

  33. Castro-Grattoni AL et al (2016) Intermittent hypoxia-induced cardiovascular remodeling is reversed by normoxia in a mouse model of sleep apnea. Chest 149:1400–1408. https://doi.org/10.1016/j.chest.2015.11.010

    Article  PubMed  Google Scholar 

  34. Altekin RE et al (2012) Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography. Int J Cardiovasc Imaging 28:1917–1930. https://doi.org/10.1007/s10554-012-0026-4

    Article  PubMed  Google Scholar 

  35. Korcarz,CE, Benca R, BarnetJH & Stein JH (2016) Treatment of obstructive sleep apnea in young and middle-aged adults: effects of positive airway pressure and compliance on arterial stiffness, endothelial function, and cardiac hemodynamics. J Am Heart Assoc 5. https://doi.org/10.1161/jaha.115.002930

Download references

Funding

YW provided financial support in the form of the National Key Research and Development Plan of China [20212BBG71004], the National Natural Science Foundation of China [82160085], the Beijing Health Promotion Association [20181BCB24013], special funds for guiding local scientific and technological development by the central government of China [S2019CXSFG0016], and the Natural science funding [20202BAB206005].

Author information

Author notes

  1. Jie Feng and Kai Li contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China

    Jie Feng, Kai Li, Wei Luo, Feng Xie, Meng Li & Yanqing Wu

Authors
  1. Jie Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kai Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Feng Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Meng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanqing Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JF and KL designed, performed, and wrote the meta-analysis. WL, FX, and ML took charge of the statistical analysis. YW revised the manuscript. All authors reviewed and agreed on this information before submission.

Corresponding author

Correspondence to Yanqing Wu.

Ethics declarations

Ethical approval

For this type of study, formal consent is not required.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Appendix

Appendix

Figs. 1, 2, 3

Fig. 1
figure 1

Flow diagram for study selection

Full size image
Fig. 2
figure 2

Forest plot

Full size image
Fig. 3
figure 3

Sensitivity analysis

Full size image

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, J., Li, K., Luo, W. et al. Effect of continuous positive pressure ventilation on left ventricular diastolic function E/A ratio in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 27, 2333–2340 (2023). https://doi.org/10.1007/s11325-023-02836-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-023-02836-x

Keywords

Search

Navigation