Aims To assess whether continuous positive airway pressure (CPAP) therapy reduces major adverse cardiovascular events (MACE) in patients with moderate-to-severe obstructive sleep apnoea (OSA). Methods and results A total of 235 articles were recovered using MEDLINE, EMBASE and Cochrane library (inception-December 2016) and references contained in the identified articles. Seven randomized controlled trials (RCTs) were selected for final analysis. Analysis of 4268 patients demonstrated non-significant 26% relative risk reduction in MACE with CPAP [risk ratio (RR) 0.74; 95% confidence interval (CI) 0.47-1.17; P = 0.19, I2 = 48%]. A series of sensitivity analyses suggested that increased CPAP usage time yielded significant risk reduction in MACE. and stroke. Subgroup analysis revealed that CPAP adherence time ≥4 hours (h)/night reduced the risk of MACE by 57% (RR 0.43; 95% CI 0.23-0.80; P = 0.01, I2 = 0%). CPAP therapy showed no beneficial effect on myocardial infarction (MI), all-cause mortality, atrial fibrillation/flutter (AF), or heart failure (HF) (P > 0.05). CPAP had positive effect on mood and reduced the daytime sleepiness [Epworth Sleepiness Scale (ESS): mean difference (MD) -2.50, 95% CI - 3.62, -1.39; P < 0.001, I2 = 81%]. Conclusion CPAP therapy might reduce MACE and stroke among subjects with CPAP time exceeding 4 h/night. Additional randomized trials mandating adequate CPAP time adherence are required to confirm this impression.

中文翻译：

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持续气道正压治疗预防阻塞性睡眠呼吸暂停患者心血管事件的荟萃分析

目的 评估持续气道正压通气 (CPAP) 治疗是否能减少中度至重度阻塞性睡眠呼吸暂停 (OSA) 患者的主要不良心血管事件 (MACE)。方法和结果 使用 MEDLINE、EMBASE 和 Cochrane 库（inception-2016 年 12 月）和已识别文章中包含的参考文献，共回收了 235 篇文章。选择了七项随机对照试验（RCTs）进行最终分析。对 4268 名患者的分析表明，使用 CPAP 后 MACE 的相对风险降低了 26% [风险比 (RR) 0.74；95% 置信区间 (CI) 0.47-1.17；P = 0.19，I2 = 48%]。一系列敏感性分析表明，增加 CPAP 使用时间可显着降低 MACE 风险。和中风。亚组分析显示，CPAP 依从时间≥4 小时 (h)/夜可使 MACE 风险降低 57%（RR 0.43；95% CI 0.23-0.80；P = 0.01，I2 = 0%）。CPAP 治疗对心肌梗死 (MI)、全因死亡率、心房颤动/扑动 (AF) 或心力衰竭 (HF) 没有显示出有益影响 (P > 0.05)。CPAP 对情绪有积极影响并减少白天嗜睡 [Epworth Sleepiness Scale (ESS): mean difference (MD) -2.50, 95% CI - 3.62, -1.39; P < 0.001，I2 = 81%]。结论 CPAP 治疗可减少 CPAP 时间超过 4 小时/晚的受试者的 MACE 和卒中。需要额外的随机试验要求足够的 CPAP 时间依从性来证实这种印象。心房颤动/扑动（AF）或心力衰竭（HF）（P > 0.05）。CPAP 对情绪有积极影响并减少白天嗜睡 [Epworth Sleepiness Scale (ESS): mean difference (MD) -2.50, 95% CI - 3.62, -1.39; P < 0.001，I2 = 81%]。结论 CPAP 治疗可减少 CPAP 时间超过 4 小时/晚的受试者的 MACE 和卒中。需要额外的随机试验要求足够的 CPAP 时间依从性来证实这种印象。心房颤动/扑动 (AF) 或心力衰竭 (HF) (P > 0.05)。CPAP 对情绪有积极影响并减少白天嗜睡 [Epworth Sleepiness Scale (ESS): mean difference (MD) -2.50, 95% CI - 3.62, -1.39; P < 0.001，I2 = 81%]。结论 CPAP 治疗可减少 CPAP 时间超过 4 小时/晚的受试者的 MACE 和卒中。需要额外的随机试验要求足够的 CPAP 时间依从性来证实这种印象。