Association of Obstructive Sleep Apnea With Risk of Serious Cardiovascular Events: Systematic Review and Meta-Analysis

Study Questions:

Is obstructive sleep apnea (OSA) associated with increased risk for cardiovascular events?


MEDLINE and EMBASE databases were searched for prospective studies, which included followed up data on patients with OSA. Studies were included if they reported on incident ischemic heart disease, stroke, and cardiovascular mortality. Outcomes data were pooled using random-effects meta-analysis and heterogeneity assessed with the I2 statistic. Regression analysis was performed to evaluate the effects of different gradations of OSA severity based on apnea-hypopnea index.


A total of nine relevant studies (from 1,731 citations) were identified and included in this review. OSA was associated with incident stroke in a meta-analysis of five studies (8,435 participants). The odds ratio (OR) for stroke associated with OSA was 2.24 (95% confidence interval [CI], 1.57-3.19; I2 = 7%). A significant association was seen in studies in which the cohort was predominately men (OR, 2.87; 95% CI, 1.91-4.31). Data on women were sparse. In an overall analysis of six studies (8,785 participants), OSA was nonsignificantly associated with ischemic heart disease (OR, 1.56; 95% CI, 0.83-2.91). Substantial heterogeneity was noted (I2 = 74%). OSA was linked to cardiovascular death in two studies involving 2,446 participants (OR, 2.09; 95% CI, 1.20-3.65; I2 = 0%). Regression analysis showed greater likelihood of stroke or cardiovascular events with increasing apnea-hypopnea index values.


The authors concluded that OSA appears to be associated with stroke, but the relationship with ischemic heart disease and cardiovascular mortality needs further research.


These data suggest a significant increased risk for cardiovascular events with OSA; however, as the authors point out, further data are needed for specific outcomes including ischemic heart disease and cardiovascular disease mortality. Given the low percentage of women in these studies, further data on women are also warranted.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Sleep Apnea

Keywords: Odds Ratio, Risk, Myocardial Ischemia, Stroke, Coronary Artery Disease, Angioplasty, Sleep Apnea Syndromes, Polysomnography, Cardiology, Cardiovascular Diseases, Confidence Intervals, Regression Analysis, MEDLINE

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