The impact of continuous positive airway pressure therapy on cardiovascular events in patients with obstructive sleep apnoea: an updated systematic review and meta-analysis.

ABSTRACT

OBJECTIVE: Obstructive sleep apnoea (OSA) is positively associated with cardiovascular diseases, and continuous positive airway pressure (CPAP) is a common treatment for such patients. This study aimed to explore the impact of CPAP on cardiovascular outcomes and prognosis in patients with OSA. METHODS: A search was conducted in the PubMed, Embase and CENTRAL databases for relevant studies published up to March 2024. Two independent reviewers screened the studies based on inclusion and exclusion criteria, and data were synthesised using RevMan 5.3 software. Heterogeneity was assessed using the Cochran Q test and the I2 statistic. RESULTS: A total of 10 randomised controlled trials and 3 observational studies, comprising 13,832 patients, were included. Compared with standard treatment, the use of CPAP did not significantly reduce the risk of major adverse cardiovascular events (MACE) (risk ratio [RR] 0.73, 95% confidence interval [CI] 0.52-1.03; p = 0.07; I2 = 66%), all-cause mortality (RR 0.92, 95% CI 0.72-1.16; p = 0.48; I2 = 0%), cardiovascular mortality (RR 0.63, 95% CI 0.33-1.19; p = 0.15; I2 = 70%) or non-cardiovascular mortality (RR 0.81, 95% CI 0.57-1.15; p = 0.23; I2 = 0%). Similarly, there were no significant differences in the incidence of myocardial infarction, stroke, hospitalisation due to unstable angina or heart failure or atrial fibrillation among those using CPAP. However, when CPAP adherence was ≥ 4 h, CPAP significantly reduced the risk of MACE and cardiovascular mortality. CONCLUSION: Although CPAP's cardiovascular benefits in patients with OSA are not confirmed, it may be that bias risks, CPAP adherence and characteristics of the study population may attenuate the perceived benefits of CPAP. Further research is needed to optimise CPAP therapy.