Efficacy of continuous positive airway pressure (CPAP) in the prevention of cardiovascular events in patients with obstructive sleep apnea: Systematic review and meta-analysis

Labarca, Gonzalo; Dreyse, Jorge; Drake, Lauren; Jorquera, Jorge; Barbé, Ferrán

doi:10.1016/j.smrv.2020.101312

Cited by 102 publications

(73 citation statements)

References 41 publications

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“…However, when the IH exposures were lengthened to 12 weeks, i.e., potentially more relevant durations as related to OSA (most patients with OSA are usually diagnosed many months or years after symptom onset), persistent disruption of the elastic laminae and ongoing pro-inflammatory signaling of aorta vascular wall macrophages was detected, suggesting that the reversibility of IH-induced vascular changes may progressively be attenuated as the duration of IH is increasingly prolonged (Cortese et al, 2017). This issue if obviously of great importance in light of the recent negative multicenter trials, whereby patients with OSA treated with CPAP did not derive specific cardiovascular benefits from the therapy (McEvoy et al, 2016;Labarca et al, 2020;Sánchez-de-la-Torre et al, 2020). Other murine studies have also shown either incomplete or timedependent functional recovery following IH-induced deficits.…”

Section: Discussionmentioning

confidence: 99%

Effects of Normoxic Recovery on Intima-Media Thickness of Aorta and Pulmonary Artery Following Intermittent Hypoxia in Mice

et al. 2020

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Obstructive sleep apnea (OSA) patients are at risk for increased blood pressure and carotid intima-media thickness (IMT), with pulmonary hypertension and right-sided heart failure potentially developing as well. Chronic intermittent hypoxia (IH) has been used as an OSA model in animals, but its effects on vascular beds have not been evaluated using objective unbiased tools. Previously published and current experimental data in mice exposed to IH were evaluated for IMT in aorta and pulmonary artery (PA) after IH with or without normoxic recovery using software for meta-analysis, Review Manager 5. Because IMT data reports on PA were extremely scarce, atherosclerotic area percentage from lumen data was also evaluated. IH significantly increased IMT parameters in both aorta and PA as illustrated by Forest plots (P < 0.01), which also confirmed that IMT values after normoxic recovery were within the normal range in both vascular beds. Onesided scarce lower areas in Funnel Plots were seen for both aorta and PA indicating the likelihood of significant publication bias. Forest and Funnel plots, which provide unbiased assessments of published and current data, suggest that IH exposures may induce IMT thickening that may be reversed by normoxic recovery in both aorta and PA. In light of the potential likelihood of publication bias, future studies are needed to confirm or refute the findings. In conclusion, OSA may induce IMT thickening (e.g., aorta and/or PA), but the treatment (e.g., nasal continuous positive airway pressure) will likely lead to improvements in such findings.

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Section: Discussionmentioning

confidence: 99%

Effects of Normoxic Recovery on Intima-Media Thickness of Aorta and Pulmonary Artery Following Intermittent Hypoxia in Mice

et al. 2020

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“…There is some evidence, albeit not firmly conclusive, that CPAP improves cognitive function in the general population with OSAS [ 9 , 10 , 11 ], but little is known about its impact in the Down syndrome population. A study of the effects of CPAP on neurobehavioral outcomes in 52 children with OSAS included 10 individuals with developmental delays, 6 of whom had Down syndrome [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Continuous positive airway pressure (CPAP) therapy is the gold-standard treatment for moderate-severe OSAS in adults, and is effective in ameliorating OSAS consequences, including excessive daytime, cognitive dysfunction and metabolic and cardiovascular outcomes in the general population although the data are not always consistent [ 9 , 10 , 11 , 12 ]. CPAP use has been shown to reduce the risk of all-cause mortality to a similar level as the general, non-OSAS, population [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

et al. 2020

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Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.

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“…Many meta-analyses showed an association between CPAP usage and a decrease in composite CV events, all-cause deaths, and CV deaths that were particularly demonstrated only in observational studies and not in randomized trials [ 20 ]. According to a systematic review and meta-analysis, done by Labarca et al, the data they collected from six randomized clinical trial (RCT)'s showed that they couldn't find any benefit from the usage of CPAP pertaining to improvement in major adverse cerebrovascular and cardiovascular endpoints (MACE) including unstable angina, MI, AF, and stroke along with all-cause mortality [ 21 ]. They also concluded that CPAP therapy was not beneficial in other CV related co-morbidities like type 2 diabetes mellitus, HTN, and dyslipidemia as well [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

Impact of Snoring on the Cardiovascular System and its Treatment: Positive and Negative Effects of Continuous Positive Airway Pressure in Sleep Apnea

Jayaprakash

Ogbue

Malhotra

et al. 2020

Cureus

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Obstructive sleep apnea (OSA) is a common condition, and if not treated can be a significant risk factor for multiple comorbidities like hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The underlying pathophysiology involves coagulation and inflammatory pathways, including an overactive sympathetic nervous system. This ultimately causes hemodynamic changes and subclinical myocardial injuries. We reviewed the published literature about the impact of continuous positive airway pressure (CPAP) when used as a mode of treatment to reduce the OSA effects on cardiomyocytes. We found that the results were mixed, including both ill and good effects. The cardiac markers like N-terminal pro-brain natriuretic peptide (NT-proBNP) and atrial natriuretic peptide (ANP) were reduced, implying the decrease in the incidence of heart failure with CPAP treatment in a few of the studies. They also proved a significant decrease in harmful cardiovascular (CV) outcomes, while others concluded that CPAP therapy might be stressful on the heart, causing an elevation in cardiac troponin T levels. However, the impact on inflammatory markers is still indeterminate and needs more research in future.

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Efficacy of continuous positive airway pressure (CPAP) in the prevention of cardiovascular events in patients with obstructive sleep apnea: Systematic review and meta-analysis

Cited by 102 publications

References 41 publications

Effects of Normoxic Recovery on Intima-Media Thickness of Aorta and Pulmonary Artery Following Intermittent Hypoxia in Mice

Effects of Normoxic Recovery on Intima-Media Thickness of Aorta and Pulmonary Artery Following Intermittent Hypoxia in Mice

Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

Impact of Snoring on the Cardiovascular System and its Treatment: Positive and Negative Effects of Continuous Positive Airway Pressure in Sleep Apnea

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