Association Of Continuous Positive Airway Pressure With Stroke And Death In Adults With Obstructive Sleep Apnea Syndrome:a Systematic Review And Meta-analysis

Objective:Obstructive sleep apnea syndrome is associated with adverse cardiovascular and cerebrovascular risk factors and increased risks of cardiovascular and cerebrovascular disease.Continuous positive airway pressure(CPAP)provides symptomatic relief,but the associations with cardiovascular and cerebrovascular outcomes and death are unclear,In particular,there are few studies on stroke outcomes.This study mainly assess the association of CPAP vs control with stroke and death in patients with obstructive sleep apnea syndrome.Methods:⑴Data sources and study selection:Pubmed,EMBASE,and the Cochrane Library were systematically searched from inception date to July 23,2019 for randomized clinical trials or prospective cohort study that included reporting of major adverse cardiovascular and cerebrovascular events or deaths.⑵Data extraction and synthesis:Independently extracted data using standardized forms.Summary Odds Ratio(OR),Risk Ratio(RR),Risk Difference(RD)and 95% CIs were obtained using random-effects meta-analysis.⑶Primary and secondary outcomes:The primary outcomes were nonfatal stroke、fatal stroke and transient ischemic attack.The secondary outcomes were all-cause deaths(Cardio-cerebrovascular death and non cardio-cerebrovascular death)、cardiovascular disease、acute coronary syndrome(Acute myocardial infarction and unstable angina)、and non cardio-cerebrovascular events.Results:The analyses included data from 10 trials of patients with obstructive sleep apnea(N?=6706;mean(SD)age,61.2(10.6)years;4286(63.9%)men;mean(SD)body mass index,31.4(6.3)kg/m~2).Among 219 stroke,37 transient ischemic attack,443all-cause deaths,641 cardiovascular disease,536 non cardio-cerebrovascular events recorded,there was significant association of continuous positive airway pressure with stroke(OR,0.52 [95% CI,0.29-0.91;P?=0.02]、RR,0.53 [95% CI,0.31-0.91;P?=?0.02] 和 RD,-0.01 [95% CI,-0.03--0.00;P?=?0.04]),Including significant association with fatal stroke(OR,0.28 [95% CI,0.11-0.73;P?=0.009]、RR,0.29 [95%CI,0.12-0.75;P?=?0.01]和 RD,-0.02 [95% CI,-0.04--0.00;P?=?0.03]),no significant association with nonfatal stroke(OR,0.79 [95% CI,0.54-1.17;P?=0.24]、RR,0.81[95% CI,0.57-1.16;P?=?0.25]和 RD,-0.01 [95% CI,-0.02-0.01;P?=?0.35]),there was no significant association of continuous positive airway pressure with transient ischemic attack(OR,1.25 [95% CI,0.63-2.47;P?=0.52]、RR,1.25 [95% CI,0.63-2.44;P?=?0.52]和 RD,0.00 [95% CI,-0.00-0.01;P?=?0.47]).In addition,there was significant association with all-cause deaths,no significant association with cardiovascular disease 、 acute coronary syndrome 、 non cardio-cerebrovascular events.Subgroup analysis showed that adherence,time of follow-up,type of study design were associated with the outcome of stroke.Conclusions:The use of continuous positive airway pressure,compared with no treatment,was associated with reduced risks of stroke outcomes and death for patients with obstructive sleep apnea syndrome.There was no evidence that it is associated with cardiovascular events or death.It may be effective to use CPAP for preventing stroke outcome,but more large-scale researches are needed.