Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies
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PURPOSE: Recent studies have shown an association between obstructive sleep apnea (OSA) and coronary artery disease; however, the association between OSA and cardiac outcomes in patients after percutaneous coronary intervention (PCI) remains undetermined. METHODS: PubMed, EMBASE, and CENTRAL were searched from inception to July 2016 for cohort studies that followed up with patients after PCI, and evaluated their overnight sleep patterns within 1 month for major adverse cardiac events (MACEs) as primary outcomes including cardiac death, non-fatal myocardial infarction (MI), and coronary revascularization and secondary outcomes including re-admission for heart failure and stroke. Outcomes data were pooled using fixed-effect meta-analysis, and heterogeneity was assessed with the I 2 statistics. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale checklist, and publication bias was evaluated by a visual investigation of funnel plots. RESULTS: We identified seven pertinent studies including 2465 patients from 178 related articles. OSA was associated with MACEs (odds ratio [OR], 1.52, 95% confidence interval [CI], 1.20-1.93, I 2 = 29%), which included cardiac death (OR 2.05, 95% CI, 1.15-3.65, I 2 = 0%), non-fatal MI (OR 1.59, 95% CI, 1.14-2.23, I 2 = 15%), and coronary revascularization (OR 1.69, 95% CI, 1.28-2.23, I 2 = 0%). However, OSA was not associated with re-admission for heart failure (OR 1.71, 95% CI, 0.99-2.96, I 2 = 0%) and/or stroke (OR 1.68, 95% CI, 0.91-3.11, I 2 = 0%) according to the pooled results. CONCLUSIONS: In patients after PCI, OSA appears to increase the risk of cardiac death, non-fatal MI, and coronary revascularization.
