Cardiovascular Outcomes in Patients With Sleep Apnea Treated With Positive Airway Pressure: Meta-Analysis of Randomized Controlled Trials

Abstract

Sleep Apnea is known to be associated with increased cardiovascular morbidity and mortality. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV). However, it is not clear whether treatment with PAP reduces cardiovascular risk. METHODS: Randomized clinical trials (RCT) that evaluated the treatment of sleep apnea with usual care (UC) plus PAP versus UC alone, and reported cardiovascular (CV) outcomes were identified via Pubmed, EMBASE, and CENTRAL. Data were combined using a random-effects meta-analysis model for each of the following outcomes: all-cause mortality, CV mortality, noncardiovascular mortality, myocardial infarction (MI), stroke, hospitalization for heart failure (HF), hospitalization for unstable angina (UA), and a subgroup analysis of major adverse cardiovascular events (CV mortality, MI, and stroke) according to adherence to PAP (<4 vs $4 h/d).