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Sleep and Breathing

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01-03-2017 | ENT • Original Article

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

Authors: Yiqun Fu, Yunyan Xia, Hongliang Yi, Huajun Xu, Jian Guan, Shankai Yin

Published in: Sleep and Breathing | Issue 1/2017

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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Title: Meta-analysis of all-cause and cardiovascular mortality in obstructive sleep apnea with or without continuous positive airway pressure treatment
Authors: Yiqun Fu
Yunyan Xia
Hongliang Yi
Huajun Xu
Jian Guan
Shankai Yin
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Sleep and Breathing / Issue 1/2017
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-016-1393-1

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