Prognostic Effects of Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure or Upper Airway Surgery on Coronary Heart Disease: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 WANG Shaoli , SHI Dazhuo , WANG Chenglong

Cardiovascular Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China;

Corresponding author：

WANG Shaoli, Email: heartmail@263.net

Keywords：

Obstructive sleep apnea; Coronary heart disease; Prognosis; Systematic Review

DOI：

10.7507/1672-2531.20120172

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate prognostic impact of treatment with Continuous Positive Airway Pressure (CPAP) or upper airway surgery on the patients with obstructive sleep apnea (OSA) and coronary heart disease (CHD).
Methods 　Database search in The Cochrane Library, PubMed, OVID and CBM (from establishment dates to October 2009) were conducted. Cohort studies and randomized controlled trials of OSA with CPAP or upper airway surgery in CHD patients were identified. We assessed the quality of the included trials and extracted the relevant data. Statistical analysis was performed using RevMan 4.3.2 software.
Results 　A total of 4 cohort studies involving 945 participants were included. The results of meta-analysis were as follows: a) there were no significant differences in the rate of late lumen loss and 10-year mortality between CHD patients with OSA treated by CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80, 95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in the treatment of OSA on CHD patients after PCI had a significant decrease in the rate of 5-year cardiac death when compared with those untreated OSA patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no differences in the rate of 5-year all-cause mortality, major adverse cardiac events (MACE) between the two groups respectively (RR=0.66, 95%CI 0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or upper airway surgery in treating OSA significantly reduced the risk of MACE occurrence during the 86.5±39 months follow-up period (RR=0.22, 95%CI 0.07 to 0.72, P=0.01).
Conclusion 　Current evidence indicates that treating OSA with CPAP or upper airway surgery in CHD patients might be associated with a decrease in the risk of cardiac death. But more studies are necessary to evaluate prognostic impact of treatment with CPAP or upper airway surgery on the patients with OSA and CHD. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.

Citation： WANG Shaoli,SHI Dazhuo,WANG Chenglong. Prognostic Effects of Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure or Upper Airway Surgery on Coronary Heart Disease: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(9): 1105-1109. doi: 10.7507/1672-2531.20120172 Copy

1.	Butt M, Dwivedi G, Khair O, et al. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol, 2009, 139(1): 7-16.
2.	Lee W, Nagubadi S, Kryger MH, et al. Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Respir Med, 2008, 2(3): 349-364.
3.	胡大一, 马长生, 方圻, 等. 心脏病学实2009: 新进展与临床案例. 北京: 人民卫生出版社, 2009: 361.
4.	Gami AS, Rader S, Svatikova A, et al. Familial premature coronary artery disease mortality and obstructive sleep apnea. Chest, 2007, 131(1): 118-121.
5.	McNicholas WT, Bonsignore MR. the Management Committee of EU Cost Action B26. Sleep apnoea as an independent risk factor for cardiovascular disease. Current evidence, basic mechanisms and research priorities. Eur Respir J, 2007, 29: 156-178.
6.	Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 2003, 290: 1906-1914.
7.	Michael T. Snoring and carotid artery atherosclerosis. Current Neurology and Neuroscience Reports, 2009, 9(2): 97-98.
8.	Sorajja D, Gami AS, Somers VK, et al. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest, 2008, 133(4): 927-933.
9.	Hagenaha GC, Gueven E, Andreas S. Influence of obstructive sleep apnoea in coronary artery disease: a 10-year follow-up. Respir Med, 2006, 100(1): 180-182.
10.	王菡侨. 睡眠呼吸暂停与心脑血管疾病. 中国全科医学, 2007, 10(2): 99-101.
11.	Cassar A, Morgenthaler TI, Lennon RJ, et al. Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention. J Am Coll Cardiol, 2007, 50(14): 1310-1314.
12.	Milleron O, Pillière R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J, 2004, 25(9): 728-734.
13.	Steiner S, Schueller PO, Hennersdorf MG, et al. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease. Respir Res, 2008, 9(1): 1-7.
14.	McDaid C, Dure´e KH, Griffin SC, et al. A systematic review of continuous positive airway pressure for obstructive sleep apnoea- hypopnoea syndrome. Sleep Med Rev, 2009, 13(6): 427-436.
15.	Martin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 2005, 365(9464): 1046-1053.
16.	Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis, 2009, 51(5): 434-451.

1. Butt M, Dwivedi G, Khair O, et al. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol, 2009, 139(1): 7-16.
2. Lee W, Nagubadi S, Kryger MH, et al. Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Respir Med, 2008, 2(3): 349-364.
3. 胡大一, 马长生, 方圻, 等. 心脏病学实2009: 新进展与临床案例. 北京: 人民卫生出版社, 2009: 361.
4. Gami AS, Rader S, Svatikova A, et al. Familial premature coronary artery disease mortality and obstructive sleep apnea. Chest, 2007, 131(1): 118-121.
5. McNicholas WT, Bonsignore MR. the Management Committee of EU Cost Action B26. Sleep apnoea as an independent risk factor for cardiovascular disease. Current evidence, basic mechanisms and research priorities. Eur Respir J, 2007, 29: 156-178.
6. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 2003, 290: 1906-1914.
7. Michael T. Snoring and carotid artery atherosclerosis. Current Neurology and Neuroscience Reports, 2009, 9(2): 97-98.
8. Sorajja D, Gami AS, Somers VK, et al. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest, 2008, 133(4): 927-933.
9. Hagenaha GC, Gueven E, Andreas S. Influence of obstructive sleep apnoea in coronary artery disease: a 10-year follow-up. Respir Med, 2006, 100(1): 180-182.
10. 王菡侨. 睡眠呼吸暂停与心脑血管疾病. 中国全科医学, 2007, 10(2): 99-101.
11. Cassar A, Morgenthaler TI, Lennon RJ, et al. Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention. J Am Coll Cardiol, 2007, 50(14): 1310-1314.
12. Milleron O, Pillière R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J, 2004, 25(9): 728-734.
13. Steiner S, Schueller PO, Hennersdorf MG, et al. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease. Respir Res, 2008, 9(1): 1-7.
14. McDaid C, Dure´e KH, Griffin SC, et al. A systematic review of continuous positive airway pressure for obstructive sleep apnoea- hypopnoea syndrome. Sleep Med Rev, 2009, 13(6): 427-436.
15. Martin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 2005, 365(9464): 1046-1053.
16. Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis, 2009, 51(5): 434-451.

Chinese Journal of Evidence-Based Medicine

Prognostic Effects of Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure or Upper Airway Surgery on Coronary Heart Disease: A Systematic Review

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