Positive airway pressure therapy and all-cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies.

We aimed to conduct a systematic reviewand meta-analysisto test the hypothesis that PAP therapy is associated with reduced all-cause and cardiovascular mortality in people with OSA.

我们的目标是进行一项系统评价和荟萃分析，以检验PAP疗法与OSA患者全因和心血管死亡率降低相关的假设。

Methods

For this systematic reviewand meta-analysis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from database inception to Aug 22, 2023 (updated Sept 9, 2024), with no language or geographical restrictions.

在进行这项系统评价和荟萃分析时，我们检索了PubMed、Embase和Cochrane中央对照试验注册库，从数据库建立之初到2023年8月22日（2024年9月9日更新），没有语言或地理限制。

Reference lists of eligible studies and recent conference abstracts (2022-23) were also reviewed.

还审查了合格研究的参考文献列表和最近的会议摘要（2022-2023年）。

We included outpatient studies (randomised controlled trials [RCTs] or confounder-adjusted, non-randomised controlled studies [NRCSs]) assessing the incidenceof all-cause mortality, cardiovascular mortality, or both in adults (aged ≥18 years) with OSA who were treated versus not treated with PAP; other study types and studies that evaluated only PAP adherence were excluded.

我们纳入了评估成人（年龄≥18岁）阻塞性睡眠呼吸暂停（OSA）患者在接受或未接受持续气道正压通气（PAP）治疗的情况下，全因死亡率、心血管死亡率或两者发生率的门诊研究（随机对照试验[RCTs]或调整混杂因素的非随机对照研究[NRCSs]）；排除了其他类型的研究以及仅评估PAP依从性的研究。

Abstracts of all retrieved publications were independently screened by two of three researchers (BS, SRB, and KCW), with disagreements resolved by adjudication from another researcher (SHM).

所有检索到的出版物摘要均由三名研究人员中的两名（BS, SRB和KCW）独立筛选，对于分歧由另一名研究人员（SHM）进行裁决解决。

The AutoLit feature of the Nested Knowledge platform was used for the review and data-extraction phases.

我们使用了嵌套知识平台的AutoLit功能进行审查和数据提取阶段。

We analysed each log-transformed hazard ratio(HR) and SE using a linear random-effects model to estimate overall HRs and 95% CIs.

我们使用线性随机效应模型分析了每个对数转换后的风险比（HR）和标准误（SE），以估计总体HR和95%置信区间。

To evaluate the risk of bias, we used the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for NRCSs.

为了评估偏倚风险，我们使用了针对随机对照试验（RCTs）的Cochrane偏倚风险工具和针对非随机对照研究（NRCSs）的新堡-渥太华量表。

This study was registered with PROSPERO, CRD42023456627.

这项研究已在PROSPERO注册，注册号为CRD42023456627。

Results

Of 5484 records identified by our search, 435 were assessed for eligibility and 30 studies were included in the systematic reviewand meta-analysis(ten RCTs and 20 NRCSs).

我们的检索共识别出5484条记录，其中435条被评估为符合资格，并且有30项研究被纳入系统评价和荟萃分析（包括10项随机对照试验和20项非随机对照研究）。

These studies included 1 175 615 participants, of whom 905 224 (77%) were male and 270 391 (23%) were female (SE 1·9), with a mean age of 59·5 (SE 1·4) years and a mean follow-up of 5·1 (0·5) years.

这些研究共纳入了1,175,615名参与者，其中905,224名（77%）为男性，270,391名（23%）为女性（标准误1.9），平均年龄为59.5（标准误1.4）岁，平均随访时间为5.1（0.5）年。

The risk of bias was low to moderate.

偏倚风险为低至中等。

The risk of all-cause mortality (HR 0·63, 95% CI 0·56-0·72; p<0·0001) and cardiovascular mortality (0·45, 0·29-0·72; p<0·0001) was significantly lower in the PAP group than in the no-PAP group, and the clinically relevant benefit of PAP therapy increased with use.

与无PAP组相比，PAP组的全因死亡风险（HR 0.63，95%置信区间0.56-0.72；p<0.0001）和心血管死亡风险（0.45，95%置信区间0.29-0.72；p<0.0001）显著降低，且PAP治疗的临床相关益处随着使用增加而增加。

interpretation

Our results are consistent with a potentially beneficial effect of PAP therapy on all-cause and cardiovascular mortality in patients with OSA.

我们的结果与持续性气道正压（PAP）疗法可能对阻塞性睡眠呼吸暂停（OSA）患者的全因死亡率和心血管死亡率有益影响一致。

Patients should be made aware of this effect of their treatment, which could result in greater acceptance of treatment initiation and greater adherence, leading to a higher likelihood of improved outcomes.

患者应被告知其治疗的这一效果，这可能导致治疗开始的更大接受度和更高的依从性，从而提高改善结果的可能性。

funding

ResMed.

ResMed 公司