Impact of Continuous Positive Airway Pressure Treatment on Left Ventricular Ejection Fraction in Patients with Obstructive Sleep Apnea: A Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundIt has been known for a long time that obstructive sleep apnea (OSA) is associated with a decreased left ventricular ejection fraction (LVEF). Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; however, it is unknown whether or not CPAP treatment will improve the LVEF. The aim of the current study was to assess whether or not CPAP treatment improves the LVEF. A meta-analysis was conducted to determine the effect of CPAP treatment on the LVEF among patients with OSA.MethodsA literature search of PubMed, the Web of Science, and Cochrane Collaboration’s database were utilized to identify eligible reports for this trial. Ten randomized controlled trails were examined and the meta-analysis was performed using STATA 11.ResultsA significant improvement in the LVEF was observed after CPAP treatment (weighted mean difference(WMD) = 3.59, 95% CI = 1.74–5.44; P<0.001). Subgroup analysis revealed that patients with OSA and heart failure had a significant improvement in the LVEF after CPAP treatment (WMD = 5.18, 95% CI = 3.27–7.08; P<0.001); however, the LVEF of patients with OSA only increased 1.11% and there was no statistical significance (WMD = 1.11, 95% CI = −1.13–3.35; P = 0.331). Furthermore, based on univariate meta-regression analysis, only the baseline AHI had a statistically significant correlation with the LVEF.ConclusionsOur meta-analysis supports the notion that CPAP may improve the LVEF among patients with OSA.

Continuous positive airway pressure therapy in non-sleepy patients with obstructive sleep apnea: results of a meta-analysis

“…Evidence has shown that CPAP treatment can greatly improve the left ventricular ejection fraction in the OSA patient with coexisting chronic heart failure (42). In addition, trials reflect that OSA patients tend to underestimate their sleepiness assessed by ESS before CPAP treatment (43).…”

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…In contrast, studies in patients with HF and CSA suggested that CPAP also can improve EF 131,134 but does not show any survival benefit. 134 A recent randomized controlled trial (Adaptive Servo Ventilation in Patients with Heart Failure [SERVE-HF]) examined the effect of adaptive servoventilation in patients with reduced EF and CSA.…”

“…128 It also improved systolic function, blood pressure, and heart rate. [129][130][131] In long-term studies, CPAP decreased mortality and improved hospitalization-free survival in patients with HF and OSA. 132,133 However, there are no double-blind randomized, controlled trials to evaluate these effects, particularly in the rehabilitation setting.…”

Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea

“…This is particularly applicable to the diagnosis and treatment of OSA, because it is known that treatment can reduce costs, 19,20 and in many cases, improve quality of life 21 and reduce morbidity from symptoms and comorbid conditions. [22][23][24][25] To this end, the AASM commissioned five Workgroups to develop quality care measures aimed at optimizing care for patients suffering from sleep-related disorders, including adult and pediatric OSA, restless legs syndrome, narcolepsy, and insomnia. 26 These quality care measures focus on both outcomes, that is, what happens to a patient as a result of the care received, and processes, or the steps taken by a healthcare provider in the care of an individual patient.…”