Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis

Yoon K Loke, J William L Brown, Chun Shing Kwok, Alagaratnam Niruban, Phyo K Myint

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

BACKGROUND: The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear. We conducted a systematic review to determine the incident risk of cardiovascular events among patients with OSA.

METHODS AND RESULTS: We searched MEDLINE and EMBASE in January 2011 for prospective studies that followed up patients with OSA for incident ischemic heart disease, stroke, and cardiovascular mortality. Outcomes data were pooled using random effects meta-analysis and heterogeneity assessed with the I(2) statistic. Regression analysis was performed to evaluate the effects of different gradations of OSA severity based on apnea-hypopnea index. We identified 9 relevant studies from 1731 citations. OSA was associated with incident stroke in a meta-analysis of 5 studies (8435 participants), odds ratio (OR) 2.24; 95% confidence interval (CI), 1.57-3.19; I(2)=7%. A significant association was seen in studies that were predominantly on men; OR, 2.87; 95% CI, 1.91-4.31, whereas data on women were sparse. In the overall analysis of 6 studies (8785 participants), OSA was nonsignificantly associated with ischemic heart disease (OR, 1.56; 95% CI, 0.83-2.91), with significant findings in the 5 studies that recruited mainly men (OR, 1.92; 95% CI, 1.06-3.48). Substantial heterogeneity was noted (I(2)=74%). OSA was linked to cardiovascular death in 2 studies involving 2446 participants (OR, 2.09; 95% CI, 1.20-3.65, I(2)=0%). Regression analysis showed greater likelihood of stroke or cardiovascular events with increasing apnea-hypopnea index values.

CONCLUSIONS: OSA appears to be associated with stroke, but the relationship with ischemic heart disease and cardiovascular mortality needs further research.

Original languageEnglish
Pages (from-to)720-728
Number of pages9
JournalCirculation. Cardiovascular quality and outcomes
Volume5
Issue number5
Early online date24 Jul 2012
DOIs
Publication statusPublished - 1 Sep 2012

Fingerprint

Obstructive Sleep Apnea
Meta-Analysis
Odds Ratio
Confidence Intervals
Myocardial Ischemia
Apnea
Stroke
Myocardial Infarction
Regression Analysis
Mortality
MEDLINE
Prospective Studies
Research

Keywords

  • aged
  • cardiovascular diseases
  • female
  • humans
  • least-squares analysis
  • male
  • middle aged
  • odds ratio
  • prognosis
  • regression analysis
  • risk assessment
  • risk factors
  • sex factors
  • sleep apnea, obstructive
  • time factors

Cite this

Association of obstructive sleep apnea with risk of serious cardiovascular events : a systematic review and meta-analysis. / Loke, Yoon K; Brown, J William L; Kwok, Chun Shing; Niruban, Alagaratnam; Myint, Phyo K.

In: Circulation. Cardiovascular quality and outcomes, Vol. 5, No. 5, 01.09.2012, p. 720-728.

Research output: Contribution to journalArticle

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T1 - Association of obstructive sleep apnea with risk of serious cardiovascular events

T2 - a systematic review and meta-analysis

AU - Loke, Yoon K

AU - Brown, J William L

AU - Kwok, Chun Shing

AU - Niruban, Alagaratnam

AU - Myint, Phyo K

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AB - BACKGROUND: The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear. We conducted a systematic review to determine the incident risk of cardiovascular events among patients with OSA.METHODS AND RESULTS: We searched MEDLINE and EMBASE in January 2011 for prospective studies that followed up patients with OSA for incident ischemic heart disease, stroke, and cardiovascular mortality. Outcomes data were pooled using random effects meta-analysis and heterogeneity assessed with the I(2) statistic. Regression analysis was performed to evaluate the effects of different gradations of OSA severity based on apnea-hypopnea index. We identified 9 relevant studies from 1731 citations. OSA was associated with incident stroke in a meta-analysis of 5 studies (8435 participants), odds ratio (OR) 2.24; 95% confidence interval (CI), 1.57-3.19; I(2)=7%. A significant association was seen in studies that were predominantly on men; OR, 2.87; 95% CI, 1.91-4.31, whereas data on women were sparse. In the overall analysis of 6 studies (8785 participants), OSA was nonsignificantly associated with ischemic heart disease (OR, 1.56; 95% CI, 0.83-2.91), with significant findings in the 5 studies that recruited mainly men (OR, 1.92; 95% CI, 1.06-3.48). Substantial heterogeneity was noted (I(2)=74%). OSA was linked to cardiovascular death in 2 studies involving 2446 participants (OR, 2.09; 95% CI, 1.20-3.65, I(2)=0%). Regression analysis showed greater likelihood of stroke or cardiovascular events with increasing apnea-hypopnea index values.CONCLUSIONS: OSA appears to be associated with stroke, but the relationship with ischemic heart disease and cardiovascular mortality needs further research.

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KW - cardiovascular diseases

KW - female

KW - humans

KW - least-squares analysis

KW - male

KW - middle aged

KW - odds ratio

KW - prognosis

KW - regression analysis

KW - risk assessment

KW - risk factors

KW - sex factors

KW - sleep apnea, obstructive

KW - time factors

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VL - 5

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JO - Circulation. Cardiovascular quality and outcomes

JF - Circulation. Cardiovascular quality and outcomes

SN - 1941-7713

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ER -