Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis

ObjectiveThis study aimed to conduct a meta-analysis to explore and summarise the evidence regarding the association between obstructive sleep apnoea (OSA) and the subsequent risk of vascular outcomes and all-cause mortality.MethodsElectronic databases PubMed, Embase and the Cochrane Library were searched to identify studies conducted through May 2016. Prospective cohort studies that reported effect estimates with 95% CIs of major adverse cardiac events (MACEs), coronary heart disease (CHD), stroke, cardiac death, all-cause mortality and heart failure for different levels versus the lowest level of OSA were included.ResultsA total of 16 cohort studies reporting data on 24 308 individuals were included. Of these, 11 studies reported healthy participants, and the remaining five studies reported participants with different diseases. Severe OSA was associated with an increased risk of MACEs (relative risk (RR): 2.04; 95% CI 1.56 to 2.66; P<0.001), CHD (RR: 1.63; 95% CI 1.18 to 2.26; P=0.003), stroke (RR: 2.15; 95% CI 1.42 to 3.24; P<0.001), cardiac death (RR: 2.96; 95% CI 1.45 to 6.01; P=0.003) and all-cause mortality (RR: 1.54; 95% CI 1.21 to 1.97; P<0.001). Moderate OSA was also significantly associated with increased risk of MACEs (RR: 1.16; 95% CI 1.01 to 1.33; P=0.034) and CHD (RR: 1.38; 95% CI 1.04 to 1.83; P=0.026). No significant association was found between mild OSA and the risk of vascular outcomes or all-cause mortality (P>0.05). Finally, no evidence of a factor-specific difference in the risk ratio for MACEs among participants with different levels of OSA compared with those with the lowest level of OSA was found.ConclusionsSevere and moderate OSAs were associated with an increased risk of vascular outcomes and all-cause mortality. This relationship might differ between genders. Therefore, further large-scale prospective studies are needed to verify this difference.

Download Full-text

Nasopharyngeal airway stenting devices for obstructive sleep apnoea: A systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215114003119 ◽

2014 ◽

Vol 129 (1) ◽

pp. 2-10 ◽

Cited By ~ 25

Author(s):

A R Kumar ◽

C Guilleminault ◽

V Certal ◽

D Li ◽

R Capasso ◽

...

Keyword(s):

Oxygen Saturation ◽

Obstructive Sleep Apnoea ◽

Meta Analysis ◽

Sleep Apnoea ◽

Cochrane Library ◽

Limited Effectiveness ◽

Obstructive Sleep ◽

Airway Stenting ◽

Nasopharyngeal Airway ◽

The Mean

AbstractObjective:To systematically review outcomes of adults with obstructive sleep apnoea treated with nasopharyngeal airway stenting devices.Methods:Medline, Scopus, Web of Science and the Cochrane Library databases were searched, and data on device use and tolerability, sleepiness, oxygen saturation, apnoea index, apnoea–hypopnoea index, and sleep quality were collected.Results:Of 573 potential studies, 29 were retrieved for detailed evaluation and 16 met the study criteria. Polysomnography data for patients treated with nasal trumpets as an isolated therapy were pooled for meta-analysis. The mean apnoea index ± standard deviation, for 53 patients, decreased from 32.4 ± 15.9 to 9.0 ± 7.2 episodes per hour (p < 0.00001). The mean apnoea–hypopnoea index, for 193 patients, decreased from 44.1 ± 18.9 to 22.7 ± 19.3 episodes per hour (p < 0.00001). The mean lowest oxygen saturation, for 193 patients, increased from 66.5 ± 14.2 to 75.5 ± 13.9 per cent (p < 0.00001).Conclusion:Some studies have demonstrated limited effectiveness and low tolerability of nasopharyngeal airway stenting devices, while other studies have shown a significant benefit in treating obstructive sleep apnoea, with a high level of patient acceptance. Nasal trumpets have been successful in decreasing airway obstruction in the short term.

Download Full-text

Obstructive sleep apnoea and the risk of type 2 diabetes: A meta-analysis of prospective cohort studies

Respirology ◽

10.1111/j.1440-1843.2012.02267.x ◽

2012 ◽

Vol 18 (1) ◽

pp. 140-146 ◽

Cited By ~ 115

Author(s):

XIA WANG ◽

YANPING BI ◽

QIAN ZHANG ◽

FANG PAN

Keyword(s):

Type 2 Diabetes ◽

Cohort Studies ◽

Obstructive Sleep Apnoea ◽

Prospective Cohort ◽

Meta Analysis ◽

Sleep Apnoea ◽

Prospective Cohort Studies ◽

Obstructive Sleep

Download Full-text

Association of angiotensin-converting enzyme gene insertion/deletion polymorphism and obstructive sleep apnoea in a Chinese population: A meta-analysis

Journal of the Renin-Angiotensin-Aldosterone System ◽

10.1177/1470320320934716 ◽

2020 ◽

Vol 21 (2) ◽

pp. 147032032093471

Author(s):

Jian Xu ◽

Jiming Chen ◽

Yilu Li ◽

Dandan Zhang ◽

Xiaoli Li

Keyword(s):

Angiotensin Converting Enzyme ◽

Obstructive Sleep Apnoea ◽

Chinese Population ◽

Meta Analysis ◽

Sleep Apnoea ◽

Sensitivity Analyses ◽

Converting Enzyme ◽

Gene Insertion ◽

Obstructive Sleep ◽

Increased Risk

Introduction: Many studies have investigated the association between angiotensin-converting enzyme ( ACE) gene insertion/deletion (I/D) polymorphism and susceptibility to obstructive sleep apnoea (OSA). However, few have confirmed the relationship between ACE and OSA in the Chinese population. We performed a meta-analysis of studies relating the ACE I/D polymorphism to the risk of OSA in a Chinese population. Methods: We evaluated eligible published studies from several databases for this meta-analysis. Subgroup analyses were performed for hypertension. Pooled odds ratios and 95% confidence intervals were calculated using a fixed- or random-effects model. Results: Ten studies were identified to analyse the association between ACE I/D polymorphism and OSA risk. No marked associations were found in any genetic model ( p>0.05). Subgroup analysis showed an association with hypertension (D vs. I, DD vs. II, ID vs. DD+II, DD+ID vs. II, ID vs. II; p<0.05), which was confirmed by sensitivity analyses. No obvious publication bias was found using Egger’s test ( p>0.05). Conclusions: The ACE I/D polymorphism was not associated with an increased risk of OSA in a Chinese population. However, within the hypertensive subgroup, we detected a significant association between the ACE polymorphism and OSA. More case-control investigations are required.

Download Full-text

Sudden death in individuals with obstructive sleep apnoea: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-039774 ◽

2020 ◽

Vol 10 (8) ◽

pp. e039774

Author(s):

Emily Heilbrunn ◽

Paddy Ssentongo ◽

Vernon M Chinchilli ◽

Anna E Ssentongo

Keyword(s):

Systematic Review ◽

Sudden Death ◽

Obstructive Sleep Apnoea ◽

Meta Analysis ◽

Cardiovascular Death ◽

Sleep Apnoea ◽

Primary Data ◽

Obstructive Sleep ◽

Increased Risk

IntroductionObstructive sleep apnoea (OSA) is a form of sleep-disordered breathing, characterised by blockage of the airway, snoring, gasping for air during sleep, daytime sleepiness and fatigue. OSA is associated with increased risk of cardiovascular and cerebrovascular morbidity and mortality, and sudden cardiac death (SCD). The magnitude of this risk varies in the literature and therefore we aim to systematically assess this risk. This study protocol proposes a meta-analysis and systematic review aimed to estimate the magnitude of the association between OSA, ‘sudden death’ and cardiovascular death.MethodsWe will conduct a systematic review and meta-analysis of studies published from the inception of each database, which report the risk of ‘sudden death’ or cardiovascular death (including SCD) in individuals diagnosed with OSA versus persons without OSA. The primary outcome of interest in this study will be the relative risk of ‘sudden death’ in patients diagnosed with OSA in comparison to those without an OSA diagnosis. We will search the following electronic research databases: PubMed (MEDLINE), Cochrane, OVID (Healthstar), OVID (Medline), Scopus and Joana Briggs Institute EBP Database. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. The checklist for this document is included in the supplemental material. Two reviewers will screen articles for inclusion criteria, extracting appropriate data and evaluating the quality of the included studies. The methodological quality of studies will be appraised using an appropriate tool. Funnel plots and the Egger’s test will be employed to evaluate potential publication bias. We will fit random-effects model with inverse-variance methods for the pooling effect estimates. We will conduct a meta-regression analysis, using numerous variables of interest including age, gender, race, body mass index, hypertension and diabetes, to explore sources of study heterogeneity.PROSPERO registration numberCRD42020164941.Ethics and disseminationNo ethics clearance was required for this protocol, for no primary data are being collected on research subjects. Only secondary analysis of pre-existing data in scientific databases will be evaluated. The findings of this meta-analysis will be published in a peer-reviewed journal and presented at scientific conferences. These results may assist professionals in the prevention and management of OSA and SCD.

Download Full-text

Upper airway volumetric changes of obstructive sleep apnoea patients treated with oral appliances: a systematic review and meta-analysis

European Journal of Orthodontics ◽

10.1093/ejo/cjaa035 ◽

2020 ◽

Author(s):

Vasileios K Dontsos ◽

Athina Chatzigianni ◽

Moschos A Papadopoulos ◽

Evangelia Nena ◽

Paschalis Steiropoulos

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnoea ◽

Meta Analysis ◽

Upper Airway ◽

Sleep Apnoea ◽

Cochrane Library ◽

Apnea Hypopnea Index ◽

Oral Appliances ◽

Volume Increase ◽

Obstructive Sleep

Summary Background Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects. Objective The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs. Search methods Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020. Selection criteria Studies were selected after the application of predetermined eligibility criteria. Data collection and analysis Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented. Results Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37–2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments. Conclusions Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.

Download Full-text

Obstructive sleep apnoea and risks of all-cause mortality: preliminary evidence from prospective cohort studies

Sleep And Breathing ◽

10.1007/s11325-015-1295-7 ◽

2016 ◽

Vol 20 (1) ◽

pp. 345-353 ◽

Cited By ~ 14

Author(s):

Lei Pan ◽

Xiaomei Xie ◽

Dayue Liu ◽

Dunqiang Ren ◽

Yongzhong Guo

Keyword(s):

Cohort Studies ◽

Obstructive Sleep Apnoea ◽

Prospective Cohort ◽

Preliminary Evidence ◽

Sleep Apnoea ◽

Prospective Cohort Studies ◽

Obstructive Sleep ◽

All Cause Mortality

Download Full-text

Co-morbid insomnia and obstructive sleep apnoea is associated with all-cause mortality

European Respiratory Journal ◽

10.1183/13993003.01958-2021 ◽

2021 ◽

pp. 2101958

Author(s):

Bastien Lechat ◽

Sarah Appleton ◽

Yohannes Adama Melaku ◽

Kristy Hansen ◽

R. Doug McEvoy ◽

...

Keyword(s):

Cardiovascular Disease ◽

Obstructive Sleep Apnoea ◽

Mortality Risk ◽

Early Morning ◽

Sleep Apnoea ◽

Health Study ◽

Obstructive Sleep ◽

Increased Risk ◽

Falling Asleep ◽

All Cause Mortality

Study ObjectivesIncreased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the combined effect of co-morbid insomnia and sleep apnoea (COMISA) on mortality risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations between COMISA and all-cause mortality risk.MethodsInsomnia was defined as difficulties falling asleep, maintaining sleep, and/or early morning awakenings from sleep ≥16 times a month and daytime impairment. OSA was defined as an apnoea-hypopnoea index ≥15 events/h sleep. COMISA was defined if both conditions were present. Multivariable adjusted Cox proportional hazard models were used to determine the association between COMISA and all-cause mortality (n=1210) over 15 years of follow-up.Results5236 participants were included. 2708 (52%) did not have insomnia/OSA (control), 170 (3%) had insomnia-alone, 2221 (42%) had OSA-alone, and 137 (3%) had COMISA. COMISA participants had a higher prevalence of hypertension (ORs [95%CI]; 2.00 [1.39, 2.90]) and cardiovascular disease compared to controls (1.70 [1.11, 2.61]). Insomnia-alone and OSA-alone were associated with higher risk of hypertension but not cardiovascular disease compared to controls. Compared to controls, COMISA was associated with a 47% (HR, 95% CI; 1.47 (1.06, 2.07)) increased risk of mortality. The association between COMISA and mortality was consistent across multiple definitions of OSA and insomnia.ConclusionsCo-morbid insomnia and sleep apnoea was associated with higher rates of hypertension and cardiovascular disease at baseline, and an increased risk of all-cause mortality compared to no insomnia/OSA.

Download Full-text

Isolated Diastolic Hypertension and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies With 489,814 Participants

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.810105 ◽

2022 ◽

Vol 8 ◽

Author(s):

Mingyan Huang ◽

Linzi Long ◽

Ling Tan ◽

Aling Shen ◽

Mi Deng ◽

...

Keyword(s):

Cohort Studies ◽

Cardiovascular Mortality ◽

Cardiovascular Events ◽

Meta Analysis ◽

The Elderly ◽

Cochrane Library ◽

Random Effects Models ◽

Increased Risk ◽

Diastolic Hypertension ◽

All Cause Mortality

Background: The association between isolated diastolic hypertension (IDH) and cardiovascular events has been inconsistently reported. This meta-analysis of cohort studies was designed to investigate the effect of the 2018 European Society of Cardiology (ESC) definition of IDH on the risk of composite cardiovascular events, cardiovascular mortality, all-cause mortality, and all strokes including ischemic stroke (IS) and hemorrhagic stroke (HS).Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 6, 2021. Cohort studies that investigated the association between IDH and cardiovascular events risk, compared to normotension, were included. Pooled hazard ratios (HRs) and 95% CIs were calculated using a random-effects models and heterogeneity was evaluated using Q-test and I2 statistic. The robustness of the associations was identified using sensitivity analysis. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale. Publication bias was assessed using funnel plot, trim-and-fill method, Begg's test, and Egger's test.Results: A total of 15 cohort studies (13 articles) including 489,814 participants were included in this meta-analysis. The follow-up period ranged from 4.3 to 29 years. IDH was significantly associated with an increased risk of composite cardiovascular events (HR 1.28, 95% CI: 1.07–1.52, p = 0.006), cardiovascular mortality (HR 1.45, 95% CI: 1.07–1.95, p = 0.015), all strokes (HR 1.44, 95% CI: 1.04–2.01, p = 0.03), and HS (HR 1.64, 95% CI: 1.18–2.29, p = 0.164), but not associated with all-cause mortality (HR 1.20, 95% CI: 0.97–1.47, p = 0.087) and IS (HR 1.56, 95% CI: 0.87–2.81, p = 0.137). Subgroup analysis further indicated that IDH in the younger patients (mean age ≤ 55 years) and from Asia were significantly associated with an increased risk of composite cardiovascular events, while the elderly patients (mean age ≥ 55 years), Americans, and Europeans were not significantly associated with an increased risk of composite cardiovascular events.Conclusion: This meta-analysis provides evidence that IDH defined using the 2018 ESC criterion is significantly associated with an increased risk of composite cardiovascular events, cardiovascular mortality, all strokes and HS, but not significantly associated with all-cause death and IS. These findings also emphasize the importance for patients with IDH to have their blood pressure within normal, especially in the young adults and Asians.Trial Registration: PROSPERO, Identifier: CRD42021254108.

Download Full-text

Lipid profile and prognosis in patients with coronary heart disease: a meta-analysis of prospective cohort studies

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01835-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiangmei Zhao ◽

Dongying Wang ◽

Lijie Qin

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cohort Studies ◽

Lipid Profile ◽

Prospective Cohort ◽

Cardiac Death ◽

Meta Analysis ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Reduced Risk

Abstract Background This meta-analysis based on prospective cohort studies aimed to evaluate the associations of lipid profiles with the risk of major adverse cardiovascular outcomes in patients with coronary heart disease (CHD). Methods The PubMed, Embase, and Cochrane Library electronic databases were systematically searched for prospective cohort study published through December 2019, and the pooled results were calculated using the random-effects model. Results Twenty-one studies with a total of 76,221 patients with CHD met the inclusion criteria. The per standard deviation (SD) increase in triglyceride was associated with a reduced risk of major adverse cardiovascular events (MACE). Furthermore, the per SD increase in high-density lipoprotein cholesterol (HDL-C) was associated with a reduced risk of cardiac death, whereas patients with lower HDL-C were associated with an increased risk of MACE, all-cause mortality, and cardiac death. Finally, the risk of MACE was significantly increased in patients with CHD with high lipoprotein(a) levels. Conclusions The results of this study suggested that lipid profile variables could predict major cardiovascular outcomes and all-cause mortality in patients with CHD.

Download Full-text