Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Prospective Studies

Obstructive sleep apnea (OSA) is a prevalent clinical disorder characterized by intermittent airway obstruction during sleep, resulting in hypoxemia and hypercapnia. Although OSA is associated with increased cardiovascular disease (CVD) risk, such as hypertension, the precise nature of this relationship remains uncertain. This systematic review and meta-analysis aim to evaluate the potential links between OSA and cardiovascular outcomes by synthesizing data from recent prospective studies. A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing electronic databases, including PubMed/MEDLINE, Scopus, and the Cochrane Library. The PICTS (patients, index test, comparator/reference test, target condition, study design) framework was used to structure the primary research question and define the investigation's scope. The Newcastle-Ottawa Scale (NOS) was employed for quality appraisal, and a meta-analysis was performed using Review Manager 5.4 software (Cochrane Collaboration, London, UK). The analysis included 12 studies, focusing on the association between OSA and various cardiovascular outcomes, including hypertension, coronary artery disease, congestive heart failure, cardiac arrhythmias, and cardiovascular events. The pooled relative risk (RR) from the random-effects model was 0.79 (95% CI: 0.56-1.03), indicating a non-significant reduction in cardiovascular risk associated with OSA. The results were heterogeneous, with individual studies showing both increased and decreased risk. Subgroup analyses based on study design, patient characteristics, and follow-up duration suggested that the observed associations were stable across different subsets of studies. However, the overall findings did not establish a definitive causal link between OSA and increased cardiovascular risk. This meta-analysis underscores the complex relationship between OSA and CVD, highlighting the need for further research to elucidate the underlying mechanisms and confirm the potential causal association. Despite the lack of significant findings, the high prevalence of OSA and its association with cardiovascular risk factors warrant routine screening and early intervention, particularly through continuous positive airway pressure (CPAP) therapy, which may mitigate the cardiovascular risks linked to OSA. Future studies should focus on high-quality prospective data and explore the impact of OSA management on cardiovascular outcomes.