Academic Editor: Takatoshi Kasai
Background: Obstructive sleep apnoea (OSA) is highly prevalent and
significantly associated with major adverse cardiovascular events (MACEs).
Continuous positive airway pressure (CPAP) treatment has a protective effect on
cardiovascular events in OSA patients. However, whether CPAP therapy significant
reduces the risk of recurrent cardiovascular (CV) events in OSA patients with
established cardiovascular or cerebrovascular diseases remains disputed. We aim
to evaluate the effect of CPAP on recurrent cardiovascular outcomes in moderate
to severe OSA patients with previous cardiovascular or cerebrovascular diseases.
Methods: We searched the electronic databases (PubMed, EMBASE, and
Cochrane library) from their inception to August, 2021. Only randomized
controlled trials (RCTs) that described the association of CPAP treatment in
patients with cardiovascular or cerebrovascular disease and OSA were included in
our analysis. The primary outcome of interest was major adverse cardiac or
cerebral events (MACCEs), a composite endpoint of myocardial infraction (MI),
non-fatal stroke, CV mortality; secondary outcomes included all-caused death,
cardiac mortality, myocardial infraction, atrial fibrillation, heart failure,
repeat revascularization, angina, stroke, and transient ischemic attack. In
addition, subgroup analyses based on CPAP adherence were performed.
Result: Six RCTs of 4493 participants were included in the analysis.
Compared with usual care, CPAP therapy did not significantly reduce the risk of
recurrent MACCEs odds ratio (OR) 0.94, 95% confidence interval (CI) 0.79–1.12,
p = 0.5, CV mortality (OR 0.83, 95% CI [0.54–1.26], p =
0.37), myocardial infarction (OR 1.09, 95% CI [0.8–1.47], p = 0.6),
heart failure (OR 0.94, 95% CI [0.66–1.33], p = 0.71), stroke (OR
0.9, 95% CI [0.67–1.23], p = 0.52), or all-cause death (OR 0.86, 95%
CI [0.63–1.16], p = 0.32). However, the subgroup analyses revealed that
CPAP can decrease the risk of CV mortality (OR 0.25, 95% CI [0.08–0.77],
p = 0.02) and stoke (OR 0.39, 95% CI [0.15–0.97], p = 0.04)
in patients who used it more than 4 hours. Conclusions: CPAP therapy was
not associated with reduce the risk of MACCEs in OSA patients with a history of
chronic cardiovascular disease who utilize CPAP