Positive airway pressure therapy and all‐cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies

IF 38.7 1区医学 Q1 CRITICAL CARE MEDICINE

Lancet Respiratory Medicine Pub Date : 2025-03-18 DOI:10.1016/s2213-2600(25)00002-5

Adam V Benjafield, Jean-Louis Pepin, Peter A Cistulli, Alison Wimms, Florent Lavergne, Fatima H Sert Kuniyoshi, Sibyl H Munson, Brendan Schuler, Shrikar Reddy Badikol, Kelly C Wolfe, Leslee Willes, Colleen Kelly, Tetyana Kendzerska, Dayna A Johnson, Raphael Heinzer, Chi-Hang Lee, Atul Malhotra

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引用次数: 0

Abstract

Background

Data regarding the effect of positive airway pressure (PAP) therapy for obstructive sleep apnoea (OSA) on all-cause mortality are inconsistent. We aimed to conduct a systematic review and meta-analysis to test the hypothesis that PAP therapy is associated with reduced all-cause and cardiovascular mortality in people with OSA.

Methods

For this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from database inception to Aug 22, 2023 (updated Sept 9, 2024), with no language or geographical restrictions. Reference lists of eligible studies and recent conference abstracts (2022–23) were also reviewed. We included outpatient studies (randomised controlled trials [RCTs] or confounder-adjusted, non-randomised controlled studies [NRCSs]) assessing the incidence of all-cause mortality, cardiovascular mortality, or both in adults (aged ≥18 years) with OSA who were treated versus not treated with PAP; other study types and studies that evaluated only PAP adherence were excluded. Abstracts of all retrieved publications were independently screened by two of three researchers (BS, SRB, and KCW), with disagreements resolved by adjudication from another researcher (SHM). The AutoLit feature of the Nested Knowledge platform was used for the review and data-extraction phases. We analysed each log-transformed hazard ratio (HR) and SE using a linear random-effects model to estimate overall HRs and 95% CIs. To evaluate the risk of bias, we used the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for NRCSs. This study was registered with PROSPERO, CRD42023456627.

Findings

Of 5484 records identified by our search, 435 were assessed for eligibility and 30 studies were included in the systematic review and meta-analysis (ten RCTs and 20 NRCSs). These studies included 1 175 615 participants, of whom 905 224 (77%) were male and 270 391 (23%) were female (SE 1·9), with a mean age of 59·5 (SE 1·4) years and a mean follow-up of 5·1 (0·5) years. The risk of bias was low to moderate. The risk of all-cause mortality (HR 0·63, 95% CI 0·56–0·72; p<0·0001) and cardiovascular mortality (0·45, 0·29–0·72; p<0·0001) was significantly lower in the PAP group than in the no-PAP group, and the clinically relevant benefit of PAP therapy increased with use.

Interpretation

Our results are consistent with a potentially beneficial effect of PAP therapy on all-cause and cardiovascular mortality in patients with OSA. Patients should be made aware of this effect of their treatment, which could result in greater acceptance of treatment initiation and greater adherence, leading to a higher likelihood of improved outcomes.

Funding

ResMed.

查看原文本刊更多论文

气道正压治疗与阻塞性睡眠呼吸暂停患者的全因死亡率和心血管死亡率：随机对照试验和混杂因素调整、非随机对照研究的系统回顾和荟萃分析

背景：关于气道正压（PAP）治疗阻塞性睡眠呼吸暂停（OSA）对全因死亡率影响的数据不一致。我们的目的是进行一项系统回顾和荟萃分析，以验证PAP治疗与OSA患者全因死亡率和心血管死亡率降低相关的假设。方法本系统综述和荟萃分析，我们检索了PubMed， Embase和Cochrane中央对照试验注册库，从数据库建立到2023年8月22日（更新于2024年9月9日），没有语言和地域限制。本文还回顾了符合条件的研究参考文献和最近的会议摘要（2022-23）。我们纳入了门诊研究（随机对照试验[RCTs]或经混杂因素调整的非随机对照研究[NRCSs]），评估接受PAP治疗与未接受PAP治疗的OSA成人（≥18岁）的全因死亡率、心血管死亡率或两者的发生率；其他研究类型和仅评估PAP依从性的研究被排除在外。所有检索到的出版物的摘要由三名研究人员中的两名（BS、SRB和KCW）独立筛选，分歧由另一名研究人员（SHM）裁决解决。在评审和数据提取阶段使用了嵌套知识平台的autoit特性。我们使用线性随机效应模型分析了每个对数转换的风险比（HR）和SE，以估计总体HR和95% ci。为了评估偏倚风险，我们对随机对照试验使用Cochrane偏倚风险工具，对nrcs使用纽卡斯尔-渥太华量表。本研究注册号为PROSPERO， CRD42023456627。在我们检索到的5484条记录中，435条被评估为合格，30项研究被纳入系统评价和荟萃分析（10项rct和20项nrcs）。共纳入1 175 615例受试者，其中男性905 224例（77%），女性270 391例（23%）（SE 1.9），平均年龄59.5岁（SE 1.4），平均随访5.1年（0.5）年。偏倚风险为低至中等。全因死亡风险(HR 0.63, 95% CI 0.56 ~ 0.72；P< 0.0001)和心血管死亡率(0.45,0.29 - 0.72；p （lt;0·0001）显著低于无PAP组，PAP治疗的临床相关获益随着使用而增加。我们的研究结果与PAP治疗对OSA患者全因死亡率和心血管死亡率的潜在有益作用是一致的。应该让患者意识到他们的治疗的这种影响，这可能导致更大的接受治疗的开始和更大的依从性，从而更有可能改善结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Respiratory Medicine RESPIRATORY SYSTEM-RESPIRATORY SYSTEM

CiteScore

87.10

自引率

0.70%

发文量

572

期刊介绍： The Lancet Respiratory Medicine is a renowned journal specializing in respiratory medicine and critical care. Our publication features original research that aims to advocate for change or shed light on clinical practices in the field. Additionally, we provide informative reviews on various topics related to respiratory medicine and critical care, ensuring a comprehensive coverage of the subject. The journal covers a wide range of topics including but not limited to asthma, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), tobacco control, intensive care medicine, lung cancer, cystic fibrosis, pneumonia, sarcoidosis, sepsis, mesothelioma, sleep medicine, thoracic and reconstructive surgery, tuberculosis, palliative medicine, influenza, pulmonary hypertension, pulmonary vascular disease, and respiratory infections. By encompassing such a broad spectrum of subjects, we strive to address the diverse needs and interests of our readership.