Is Obstructive Sleep Apnea Associated with Cardiovascular and All-Cause Mortality?

Xiahui Ge,Yue Zhang,Tianyun Yang,Chong Bai,Xuejun Guo,Fengfeng Han,Yanxi Huang,Annette Sterr

doi:10.1371/journal.pone.0069432

Abstract

BackgroundStudies have reported inconsistent findings regarding the association between obstructive sleep apnea (OSA) and future risks of cardiovascular and all-cause mortality. We conducted a meta-analysis to investigate whether OSA is an independent predictor for future cardiovascular and all-cause mortality using prospective observational studies.MethodsElectronic literature databases (Medline and Embase) were searched for prospective observational studies published prior to December 2012. Only observational studies that assessed baseline OSA and future risk of cardiovascular and all-cause mortality were selected. Pooled hazard risk (HR) and corresponding 95% confidence intervals (CI) were calculated for categorical risk estimates. Subgroup analyses were based on the severity of OSA.ResultsSix studies with 11932 patients were identified and analyzed, with 239 reporting cardiovascular mortality, and 1397 all-cause mortality. Pooled HR of all-cause mortality was 1.19 (95% CI, 1.00 to 1.41) for moderate OSA and 1.90 (95% CI, 1.29 to 2.81) for severe OSA. Pooled HR of cardiovascular mortality was 1.40 (95% CI, 0.77 to 2.53) for moderate OSA and 2.65 (95% CI, 1.82 to 3.85) for severe OSA. There were no differences in cardiovascular mortality in continuous positive airway pressure (CPAP) treatment compared with healthy subjects (HR 0.82; 95% CI, 0.50 to 1.33).ConclusionsSevere OSA is a strong independent predictor for future cardiovascular and all-cause mortality. CPAP treatment was associated with decrease cardiovascular mortality.

Highlights

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstructions of the upper airway during sleep
Study Selection Studies satisfying the following criteria were included in the prospective observational meta-analysis: 1) adults who had been diagnosed with obstructive sleep apnea (OSA), of any severity, confirmed by using a standardized polysomnography; and 2) providing adjusted hazard risk (HR) and the 95% confidence interval (CI) dealing with the risk of cardiovascular and all-cause mortality with varying degrees of OSA severity patients compared with without OSA
Literature Search Following the application of the search strategy, a total of 1431 potentially relevant citations were identified in our initial literature search

Summary

Introduction

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstructions of the upper airway during sleep. Untreated OSA is associated with significant cardiovascular morbidity and mortality, debilitating daytime symptoms and increased risk of work and motor vehicle accidents. OSA has been reported to be associated with increased cardiovascular mortality [5,6,7,8,9] and all-cause mortality [6,9,10,11,12,13,14], and in particular with coexistence of OSA and cardiovascular disease [15,16,17,18,19]. Studies have reported inconsistent findings regarding the association between obstructive sleep apnea (OSA) and future risks of cardiovascular and all-cause mortality. We conducted a meta-analysis to investigate whether OSA is an independent predictor for future cardiovascular and all-cause mortality using prospective observational studies

Methods

Results

Conclusion