Does continuous positive airway pressure therapy benefit patients with coronary artery disease and obstructive sleep apnea? A systematic review and meta‐analysis

Chen, Yasha; Chen, Yihong; Wen, Feng; He, Zhiqing; Niu, Wenhao; Ren, Changzhen; Li, Na; Wang, Qinqin; Ren, Yusheng; Liang, Chun

doi:10.1002/clc.23669

Cited by 10 publications

(12 citation statements)

References 47 publications

(123 reference statements)

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“…Continuous Positive Airway Pressure (CPAP) is the treatment of choice for moderate to severe OSAS (Zhang et al, 2015;Chen et al, 2021;Sugiyama et al, 2021). It involves the use of an airflow generator which provides a constant stream of pressurized air to splint open and maintain patency of the upper airways during the inspiratory and expiratory phases of breathing.…”

Section: Introductionmentioning

confidence: 99%

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

et al. 2021

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Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures.Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of “obstructive sleep apnea syndrome,” “continuous positive airway pressure,” “motivational intervention,” and “adherence.” Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis.Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing adherence to CPAP, despite results were not always maintained over time across studies.Discussion: To our knowledge, this is the first scoping review of the literature aimed to explore the characteristics and impact of motivational interventions to promote adherence to CPAP in patients with OSAS. More research providing a detailed description of motivational strategies, and testing of their association with positive treatment outcomes via both direct and indirect measures are needed to increase awareness on active mechanisms of change.

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Section: Introductionmentioning

confidence: 99%

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

et al. 2021

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“…OSA induces a proinflammatory state in our body, as evidenced by increased C-reactive protein levels. 19 In a study conducted by Zhong et al, 20 it was found that patients with OSA and hypopnea syndrome have impaired baseline endothelial function and autonomic modulation compared to their non OSAHS counterparts. Vascular cell adhesion factor 1 (VCAM-1) levels were significantly elevated in patients with moderate and severe OSA, and elevated VCAM-1 was positively associated with the severity of CAD in moderate to severe OSA patients.…”

Section: Central Sleep Apneamentioning

confidence: 99%

“…OSA may overactivate the sympathetic nervous system promoting release of vasoconstrictor like catecholamines, angiotensin II, causing an increase in night blood pressure and heart rate, and may result in increasing myocardial oxygen demand and cardiac load leading to a cardiovascular event. 19 OSA may be responsible for an increased risk of major adverse cardiovascular event even after percutaneous coronary intervention (PCI). 23 The mechanism of how CSA impacts overall cardiovascular health is similar to OSA.…”

Section: Central Sleep Apneamentioning

confidence: 99%

“…Patients with CAD and OSA who were using CPAP showed a significantly reduced risk of major cardiovascular events (RR, 0.73; 95% CI, 0.55–0.96), particularly among those with AHI less than 30 events/h (RR, 0.43; 95% CI, 0.22–0.84). 19 Diabetes is also another known contributing factor of CAD. A retrospective cohort study of 1206 subjects found that regular CPAP use for patients with moderate to severe OSA was associated with a reduction of diabetes incidence from 3.41 to 1.61 per 100 person/years.…”

Section: Role Of Continuing Positive Pressure Therapy In Modulating C...mentioning

confidence: 99%

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Sleep Disorders and Coronary Artery Disease

Dey¹,

Sun²,

Frishman³

et al. 2022

Cardiology in Review

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A sufficient amount and quality sleep is vital components for maintaining optimal physical wellbeing, cognition, and cardiovascular health. Normal sleep provides us with a low physiological stress that promotes overall cardiovascular health. Sleep disorders are common, and often goes undiagnosed. Patients with sleep disorders, commonly suffer from poor quality of life due to the poor quality of their sleep. They are associated with adverse effects on cardiovascular health, such as coronary artery disease. Sleep disorders discussed in this review article include sleep-disordered breathing (obstructive sleep apnea and central sleep apnea), insomnia and restless leg syndrome. Sleep disorders primarily have four acute adverse cardiovascular consequences. First, intermittent hypoxemia-reoxygenation in arterial blood along with PCO 2 fluctuation; second is excessive arousals; third, decreased parasympathetic and increased sympathetic tone; fourth being the large pressure swings in the intrathoracic cavity. This review focuses on classifications, and prevalence of the three major classes of sleep disorders, and the evidence to date on the association between these sleep disorders and coronary artery disease.

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“…This article examines the relationship between OSA and cardiovascular risk in addition to reviewing recent clinical studies, systematic reviews, and meta-analyses on the effectiveness of CPAP in primary and secondary cardiovascular prevention. Type II diabetes mellitus and OSA usually coexist together as per estimates from clinics, type II diabetics with OSA have a prevalence of 18% to 36% [ 1 - 3 ], and 50% of OSA patients also have type II diabetes or impaired glucose metabolism [ 9 ]. Early CPAP therapy improves long-term survival in individuals with ischemic stroke with moderate-severe OSA [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

From Snoring to Soaring: Unveiling the Positive Effects of Continuous Positive Airway Pressure Ventilation on Cardiovascular Health in Patients With Obstructive Sleep Apnoea Through a Systematic Review

Swami,

Aye,

Trivedi

et al. 2023

Cureus

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Increased cardiovascular (CV) morbidity and death are linked to obstructive sleep apnoea (OSA). The primary method of treating OSA is continuous positive airway pressure (CPAP). CPAP has some debatable outcomes on CV events in people suffering from OSA. The current study investigates how CPAP affects CV outcomes. The goal is to evaluate CPAP's effectiveness in lowering CV outcomes in OSA patients. We used a computer to search the PubMed, PubMed Central Library, Science Direct, and Google Scholar databases for studies comparing the effects of CPAP and a control group on CV outcomes in OSA patients. These included randomised control trials (RCT), narrative reviews, systematic reviews, case-control studies, observational studies and meta-analyses. A total of 52,937 patients were included in the final analysis of six RCTs, four observational studies, 10 meta-analyses, one case-control study, two systematic reviews and one narrative review. The weighted mean follow-up lasted for a period of between three months and nine years. The risk of major cardiovascular adverse events (MACE) was the same for both the CPAP and control groups. According to subgroup analysis, patients with lower MACE adherence rates (four hours per night) were more likely to use CPAP. The risk of all-cause mortality, CV-related complications causing mortality, acute myocardial infarction acute stroke, or hospitalisations for angina was the same in the CPAP and control groups. The primary outcome was that in patients with therapy with CPAP in addition to usual care and usual care alone did not prevent CV events in patients with moderate-to-severe OSA and existing CV illness. Patients with OSA who utilise CPAP may not experience fewer CV events. Patients who use CPAP consistently (four hours per night) could benefit from improved CV results. Future research must assess how well-adherent patients with severe OSA and low CV event rates respond to CPAP therapy. In patients who use CPAP for more than four hours each night, CPAP therapy may minimise the risk of MACE and stroke. Additional randomised trials requiring adequate CPAP time adherence are needed to support this perception. Despite the fact that there is no evidence to support the claim that CPAP therapy improves CV outcomes, bias difficulties, CPAP adherence problems, and the patient groups included in each RCT may have made it more difficult to generalise the findings to all patients. Future research is therefore needed to look at these relevant results.

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Does continuous positive airway pressure therapy benefit patients with coronary artery disease and obstructive sleep apnea? A systematic review and meta‐analysis

Cited by 10 publications

References 47 publications

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

Sleep Disorders and Coronary Artery Disease

From Snoring to Soaring: Unveiling the Positive Effects of Continuous Positive Airway Pressure Ventilation on Cardiovascular Health in Patients With Obstructive Sleep Apnoea Through a Systematic Review

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