Association of Sleep-Disordered Breathing With Cardiovascular Events and Death in patients With Ischemic Heart Disease：A systematic review and meta-analysis

Objective Previous studies have identified that sleep-disordered breathing is associated with the increased risk of cardiovascular disease. However, CPAP, the preferred treatment of sleep apnea, does not appear to reduce the risk of adverse cardiovascular events and deaths in ischemic heart disease. Our aim was to determine whether OSA can be a prognostic factor for cardiovascular adverse events and deaths in patients with ischemia heart disease. Methods We searched Medline via PubMed, Embase, and the Cochrane Library database for clinical studies reporting the major adverse cardiac outcomes of SDB in patients with myocardial ischemia. Sleep apnea tests is mainly performed with cardiorespiratory polygraphy or portable diagnostic device. Summary hazard ratio(HR) and 95% CIs were conducted using random-effects meta-analysis. Results Eighteen literatures were included, with total participants of 9,138. Sixteen studies reported MACCEs, there was significant association of SDB with MACCES (HR, 1.66[95% CI, 1.41 to 1.94]; P< 0.0001), all-cause mortality (HR, 1.39[95% CI 1.12 to 1.73], P=0.0027) and cardiovascular mortality (HR, 2.12[95% CI 1.23 to 3.65], P=0.007). Subgroup analysis showed that one study was the cause of heterogeneity, while no correlation between SDB and outcomes for sleep apnea severity, follow-up time or whether surgery was performed. Conclusion SDB is associated with adverse cardiac outcomes in patients with ischemic heart disease, suggesting that sleep apnea can be screened for patients with ischemic heart disease, which can be used as a clinically relevant strategy of secondary prevention to reduce the risk of adverse outcomes.