Background
Comorbidity of obstructive sleep apnea (OSA) and heart failure (HF) is becoming increasingly common. This is a global analysis of positive airway pressure (PAP) efficacy for the cardiovascular outcomes in those HF Patients with comorbid OSA.
Methods
Related randomized controlled trials were included. Analysed indicators covered primary outcomes (cardiac function, motor ability and life quality) and secondary outcomes (blood pressure and OSA‐accompanying symptoms). Weighted mean difference was used to analyse the PAP‐control difference in different experimental phases and the baseline‐post difference in different groups.
Results
Compared with control group, PAP was associated with a 3.48% increase in left ventricle ejection fraction (LVEF) (p < .00001) and little decrease in heart rate (HR) (p = .67). Over 6 h of mean nighttime use was associated with a greater increase in LVEF of 5.21% (p = .0002) and a significant reduction in HR of 3.81 bpm (p = .03). There was no significant difference between PAP and control group in their association with change in motor ability and life quality. Besides, PAP was associated with a 13.08 mm Hg decrease in systolic blood pressure and great improvements in OSA‐accompanying symptoms: Apnea–Hypopnea Index, −23.73 e/h; mean oxygen saturation, 1.86%; minimum oxygen saturation, 8.78%; Epworth Sleepiness Scale, −1.39 point; arousal index, −16.41 e/h. There was also no significant difference in diastolic blood pressure.
Conclusions
Positive airway pressure treatment improves cardiac function in HF patients with comorbid OSA, but the improved magnitude is associated with the duration of nighttime use rather than the duration of treatment.
SummaryObstructive sleep apnea (OSA) and cardiovascular co‐morbidities have a mutually reinforcing effect, but existing studies have focussed only on the improvement of the associated co‐morbidities by treatment for OSA. To provide fresh guidelines for the treatment of OSA from a co‐morbidity standpoint, we conducted a systematic search of Web of Science, PubMed, EMBASE, and the Cochrane Library for articles published from inception up to 2 May 2023. Fourteen original studies of patients with OSA with cardiovascular co‐morbidities and who received related treatment were included in the analysis. We found that diuretic treatment can reduce the apnea–hypopnea index in patients with OSA and hypertension (−19.41/h, p = 1.0 × 10−5), aldosterone‐angiotensin inhibitors also have a 9.19/h reduction (p = 0.003), while the effect of renal sympathetic denervation is insignificant (−2.32/h, p = 0.19). The short‐term treatment (<4 weeks) did not show an improvement (−2.72/h, p = 0.16), while long‐term treatment (>4 weeks) produced surprising outcomes (−12.78/h, p = 0.002). Patients with milder disease (baseline AHI < 35/h) had insignificant improvements (−1.05/h, p = 0.46), whereas those with more severe disease (baseline AHI > 35/h) could achieve satisfactory outcomes (−14.74/h, p < 0.00001). In addition, it also showed some improvement in the oxygen desaturation index and blood oxygen. Our results support the additional benefit of antihypertensive treatment for OSA symptoms, and the efficacy can be affected by different therapy, treatment duration, and severity levels. It could be useful in developing clinical therapy, educating patients, and exploring interaction mechanisms. The proposal was registered with PROSPERO (CRD42022351206).
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