Continuous positive airway pressure for adults with obstructive sleep apnea and cardiovascular disease: a meta-analysis of randomized trials

Paulitsch, Felipe da Silva; Zhang, Linjie

doi:10.1016/j.sleep.2018.09.030

Cited by 56 publications

(25 citation statements)

References 30 publications

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“…53,54 Two recent metaanalyses also confirm that CPAP does not improve survival or prevent the development of major cardiovascular events in patients with OSA. 55,56 There may be several explanations for this. better risk stratification, as well as the use of biomarkers able to identify subgroups of patients with OSA with a high risk of cardiovascular or metabolic events, might facilitate reassessment of the role and efficacy of OSA treatment in both primary and secondary prevention.…”

Section: Secondary Cardiovascular Preventionmentioning

confidence: 99%

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Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

et al. 2020

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Obstructive sleep apnoea (OSA) syndrome is characterised by the presence of apnoea or obstructive hypopnoea during sleep, accompanied by hypoxia. It is estimated that the syndrome affects approximately 10% of men and 15% of women. Diagnosis and treatment rates have increased in recent years, but the condition remains undiagnosed in a high percentage of patients. Recent evidence suggests that OSA may increase the risk of cardiovascular disease. The relationship between OSA and cardiovascular disease can be explained, at least in part, by the coexistence of cardiovascular risk factors in the two pathologies, such as age, overweight, smoking and sedentary lifestyle. However, OSA has been independently associated with the risk of developing hypertension, cerebrovascular disease, ischaemic heart disease, heart failure and arrhythmias. Clinical trials that have evaluated the efficacy of continuous positive airway pressure (CPAP) treatment in primary and secondary cardiovascular prevention have not demonstrated a significant reduction in the incidence or recurrence of cardiovascular events. This article analyses the relationship between OSA and cardiovascular risk and discusses recent clinical trials on the efficacy of CPAP in primary and secondary cardiovascular prevention.

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Section: Secondary Cardiovascular Preventionmentioning

confidence: 99%

“…[ 53 , 54 ] Two recent meta-analyses also confirm that CPAP does not improve survival or prevent the development of major cardiovascular events in patients with OSA. [ 55 , 56 ] There may be several explanations for this.…”

Section: Sleep Apnoea Syndrome and Cardiovascular Diseasementioning

confidence: 99%

Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

et al. 2020

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“…However, and to the substantial surprise of the sleep research community, the use of CPAP was not associated with reduced risks of cardiovascular outcomes, diabetes mellitus, or death for patients with OSA in recent randomized controlled trials. 63–68 Therefore, it is essential to develop novel pharmacological agents to counteract the pathophysiological mechanisms responsible for OSA-related adverse consequences, namely oxidative stress, sympathetic activation, and low-grade inflammation. 63 Beneficial effects of CPAP therapy on the level of microparticles (MPs) were reported in a small trial that consisted of the withdrawal of CPAP therapy for 2 weeks.…”

Section: Obstructive Sleep Apnea and Cardiovascular Morbidity And Trementioning

confidence: 99%

Cardiovascular morbidities of obstructive sleep apnea and the role of circulating extracellular vesicles

Castro-Grattoni

Gozal

2019

Ther Adv Respir Dis

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Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse during sleep resulting in impaired blood gas exchange, namely intermittent hypoxia (IH) and hypercapnia, fragmented sleep (SF), increased oxidative stress and systemic inflammation. Among a myriad of potential associated morbidities, OSA has been particularly implicated as mechanistically contributing to the prevalence and severity of cardiovascular diseases (CVD). However, the benefits of continuous positive airway pressure (CPAP), which is generally employed in OSA treatment, to either prevent or improve CVD outcomes remain unconvincing, suggesting that the pathophysiological mechanisms underlying the incremental CVD risk associated with OSA are not clearly understood. One of the challenges in development of non-invasive diagnostic assays is the ability to identify clinically and mechanistically relevant biomarkers. Circulating extracellular vesicles (EVs) and their cargos reflect underlying changes in cellular homeostasis and can provide insights into how cells and systems cope with physiological perturbations by virtue of the identity and abundance of miRNAs, mRNAs, proteins, and lipids that are packaged in the EVs under normal as well as diseased states, such as OSA. EVs can not only provide unique insights into coordinated cellular responses at the organ or systemic level, but can also serve as reporters of the effects of OSA in CVD, either by their properties enabling regeneration and repair of injured vascular cells or by damaging them. Here, we highlight recent progress in the pathological CVD consequences of OSA, and explore the putative roles of EVs in OSA-associated CVD, along with emerging diagnostic and therapeutic opportunities. The reviews of this paper are available via the supplemental material section.

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“…Because of the high prevalence, haz-ard, and economic burden, the prevention and treatment of OSA is of great importance. Currently, therapies for OSA have been designed and proposed to reduce the frequency of sleep-disordered breathing events, including continuous positive airway pressure (CPAP) [7], surgical procedures [8], weight loss and lifestyle interventions [9,10], and pharmacotherapy [11]. One traditional and novel intervention is the application of acupuncture [12].…”

Section: Introductionmentioning

confidence: 99%

Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis

Wang

Zhan

et al. 2020

BioMed Research International

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Objective. Our aim was to assess the efficacy and safety of acupuncture for OSA patients with various severities of the disorder. Methods. Eight databases including PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) were comprehensively searched till July 2019. Randomized controlled trials (RCTs) testing acupuncture in the treatment of OSA were eligible for inclusion. Studies were selected for inclusion, and data were extracted by two authors independently. The Cochrane Collaboration’s Risk of Bias Assessment Tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis. Results. Nine RCTs with 584 participants were included. The trials covered acupuncture and electropuncture. Acupuncture caused clinically significant reductions in AHI (MD: -6.18; 95% CI: -9.58 to -2.78; Z=3.56, P=0.0004) as well as in ESS (MD: -2.84; 95% CI: -4.80 to -0.16, Z=2.09, P=0.04). AHI was reduced more in the subgroup analysis of moderate OSA patients (MD: -9.44; 95% CI: -12.44 to -6.45; Z=6.18, P<0.00001) and severe OSA patients (MD: -10.09; 95% CI: -12.47 to -7.71; Z=8.31, P<0.00001). ESS was also reduced more in the subgroup analysis of moderate OSA patients (MD: -2.40; 95% CI: -3.63 to -1.17; Z=3.83, P=0.0001) and severe OSA patients (MD: -4.64; 95% CI: -5.35 to -3.92; Z=12.72, P<0.00001). Besides, acupuncture had a beneficial effect on LSaO2 (MD: 5.29; 95% CI: 2.61 to 7.97; Z=3.86, P=0.0001). The outcome of AHI and LSaO2 yielded consistent results after sensitivity analysis, but the direction of the outcome of ESS was reversed. And the quality of evidence was mainly low to very low. Conclusions. Acupuncture therapy is effective for OSA patients in reducing AHI and ESS and in improving the LSaO2 of various severities, especially in moderate and severe OSA patients. High-quality trials are urgently needed.

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Continuous positive airway pressure for adults with obstructive sleep apnea and cardiovascular disease: a meta-analysis of randomized trials

Cited by 56 publications

References 30 publications

Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

Cardiovascular morbidities of obstructive sleep apnea and the role of circulating extracellular vesicles

Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis

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