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Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis
  1. Chengjuan Xie1,
  2. Ruolin Zhu1,
  3. Yanghua Tian1,2,
  4. Kai Wang1,2,3
  1. 1 Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
  2. 2 Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, China
  3. 3 Department of Medical Psychology, Anhui Medical University, Hefei, China
  1. Correspondence to Dr Kai Wang; wangkai1964{at}


Objective This study aimed to conduct a meta-analysis to explore and summarise the evidence regarding the association between obstructive sleep apnoea (OSA) and the subsequent risk of vascular outcomes and all-cause mortality.

Methods Electronic databases PubMed, Embase and the Cochrane Library were searched to identify studies conducted through May 2016. Prospective cohort studies that reported effect estimates with 95% CIs of major adverse cardiac events (MACEs), coronary heart disease (CHD), stroke, cardiac death, all-cause mortality and heart failure for different levels versus the lowest level of OSA were included.

Results A total of 16 cohort studies reporting data on 24 308 individuals were included. Of these, 11 studies reported healthy participants, and the remaining five studies reported participants with different diseases. Severe OSA was associated with an increased risk of MACEs (relative risk (RR): 2.04; 95% CI 1.56 to 2.66; P<0.001), CHD (RR: 1.63; 95% CI 1.18 to 2.26; P=0.003), stroke (RR: 2.15; 95% CI 1.42 to 3.24; P<0.001), cardiac death (RR: 2.96; 95% CI 1.45 to 6.01; P=0.003) and all-cause mortality (RR: 1.54; 95% CI 1.21 to 1.97; P<0.001). Moderate OSA was also significantly associated with increased risk of MACEs (RR: 1.16; 95% CI 1.01 to 1.33; P=0.034) and CHD (RR: 1.38; 95% CI 1.04 to 1.83; P=0.026). No significant association was found between mild OSA and the risk of vascular outcomes or all-cause mortality (P>0.05). Finally, no evidence of a factor-specific difference in the risk ratio for MACEs among participants with different levels of OSA compared with those with the lowest level of OSA was found.

Conclusions Severe and moderate OSAs were associated with an increased risk of vascular outcomes and all-cause mortality. This relationship might differ between genders. Therefore, further large-scale prospective studies are needed to verify this difference.

  • meta-analysis
  • mortality
  • obstructive sleep apnea
  • vascular outcome

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  • Contributors CX carried out the studies, participated in collecting data and drafted the manuscript. RZ performed the statistical analysis and participated in its design. YT and KW helped to draft the manuscript. All authors read and approved the final manuscript.

  • Funding This research was supported by the National Basic Research Program of China (nos. 973 Program 2015CB856405 and 2012CB720704) and the National Natural Science Foundation of China (nos. 31571149, 91432301, 81301176 and 81171273).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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