Date Published: July 25, 2013
Publisher: Public Library of Science
Author(s): Xiahui Ge, Fengfeng Han, Yanxi Huang, Yue Zhang, Tianyun Yang, Chong Bai, Xuejun Guo, Annette Sterr.
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.
Electronic 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.
Six 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).
Severe OSA is a strong independent predictor for future cardiovascular and all-cause mortality. CPAP treatment was associated with decrease cardiovascular mortality.
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstructions of the upper airway during sleep. Prevalence of OSA with an apnea-hypopnea index (AHI) exceeding 10–15 is 7–10% in the general adult population , and approximately 2–4% of the adult population between the ages of 30 and 60 years occurs excessive daytime somnolence . Untreated OSA is associated with significant cardiovascular morbidity and mortality, debilitating daytime symptoms and increased risk of work and motor vehicle accidents.
The findings of the current meta-analysis provided evidence that severe OSA is a strong independent predictor for future cardiovascular and all-cause mortality. Subjects with severe OSA increased 67% risk of all-cause mortality and 265% risk of cardiovascular mortality. In addition, CPAP treatment was associated with decrease cardiovascular mortality.