Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea A Systematic Review and Meta-analysis
Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea A Systematic Review and Meta-analysis
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DOI：
10.1001/jama.2017.7967
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发表时间：
2017-07-11
影响因子：
120.7
通讯作者：
Neal, Bruce
中科院分区：
文献类型：
--
作者：
Yu, Jie;Zhou, Zien;Neal, Bruce
重要性 睡眠呼吸暂停（阻塞性和中枢性）与不良心血管危险因素和心血管疾病风险增加有关。气道正压通气 (PAP) 可以缓解症状，无论是持续通气 (CPAP) 还是自适应伺服通气 (ASV)，但与心血管结局和死亡的关联尚不清楚。 目的 评估 PAP 与控制与睡眠呼吸暂停患者心血管事件和死亡之间的关联。 数据来源和研究选择 从开始日期到 2017 年 3 月，系统地检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，用于随机临床研究包括报告主要不良心血管事件或死亡的试验。数据提取和合成两位作者使用标准化表格独立提取数据。使用随机效应荟萃分析获得相对风险 (RR)、风险差异 (RD) 和 95% CI 的摘要。 主要结果和测量 主要结果是急性冠状动脉综合征 (ACS) 事件、中风或血管性死亡（主要不良心血管事件）的综合结果；特定原因的血管事件；结果 分析包括来自 10 项试验（9 项 CPAP；1 项 ASV）的数据，受试者为睡眠呼吸暂停患者（N = 7266；平均年龄，60.9 [范围，51.5 至 71.1] 岁；5847 [80.5%] 男性；平均 [SD] 体重指数，30.0 [5.2]。其中 356 例主要不良心血管事件和 613 例死亡据记录，PAP 与主要不良心血管事件（RR，0.77 [95% CI，0.53 至 1.13]；P=.19 和 RD，-0.01 [95% CI，-0.03 至 0.01]；P=.23）、心血管死亡（RR，1.15 [95% CI，0.88 至 1.50]；P=.30 和RD -0.00 [95% CI，-0.02 至 0.02]；P=.87），或全因死亡（RR，1.13 [95% CI，0.99 至 1.29]；P=.08 和 RD，0.00 [95% CI，-0.01 至 0.01]；P=.51）。没有证据表明 CPAP 与 ASV 存在不同的关联（所有 P 值同质性 >.24），荟萃回归发现 PAP 与不同程度的呼吸暂停严重程度、随访持续时间或 PAP 依从性没有关联（所有 P 值 >.13）。结论和相关性 与不治疗或假手术相比，使用 PAP 与睡眠患者心血管结局或死亡风险降低无关。尽管 PAP 治疗睡眠呼吸暂停还有其他好处，但这些研究结果并不支持 PAP 治疗的目的是预防这些结果。
IMPORTANCE Sleep apnea (obstructive and central) is associated with adverse cardiovascular risk factors and increased risks of cardiovascular disease. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV), but the associations with cardiovascular outcomes and death are unclear.OBJECTIVE To assess the association of PAP vs control with cardiovascular events and death in patients with sleep apnea.DATA SOURCES AND STUDY SELECTION MEDLINE, EMBASE, and the Cochrane Library were systematically searched from inception date to March 2017 for randomized clinical trials that included reporting of major adverse cardiovascular events or deaths.DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data using standardized forms. Summary relative risks (RRs), risk differences (RDs) and 95% CIs were obtained using random-effects meta-analysis.MAIN OUTCOMES AND MEASURES The main outcomes were a composite of acute coronary syndrome (ACS) events, stroke, or vascular death (major adverse cardiovascular events); cause-specific vascular events; and death.RESULTS The analyses included data from 10 trials (9 CPAP; 1 ASV) of patients with sleep apnea (N = 7266; mean age, 60.9 [range, 51.5 to 71.1] years; 5847 [80.5%] men; mean [SD] body mass index, 30.0 [5.2]. Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse cardiovascular events (RR, 0.77 [95% CI, 0.53 to 1.13]; P=.19 and RD, -0.01 [95% CI, -0.03 to 0.01]; P=.23), cardiovascular death (RR, 1.15 [95% CI, 0.88 to 1.50]; P=.30 and RD -0.00 [95% CI, -0.02 to 0.02]; P=.87), or all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P=.08 and RD, 0.00 [95% CI, -0.01 to 0.01]; P=.51). The same was true for ACS, stroke, and heart failure. There was no evidence of different associations for CPAP vs ASV (all P value homogeneity >.24), and meta-regressions identified no associations of PAP with outcomes for different levels of apnea severity, follow-up duration, or adherence to PAP (all P values >.13).CONCLUSIONS AND RELEVANCE The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea. Although there are other benefits of treatment with PAP for sleep apnea, these findings do not support treatment with PAP with a goal of prevention of these outcomes.