坚持CPAP治疗和心血管事件的风险:一个元分析
Manuel Sánchez-de-la-Torre1,2, Esther Gracia-Lavedan2,3, Ivan D Benitez1,2
1Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
JAMA
|October 3, 2023
概括
对阻塞性睡眠呼吸暂停 (OSA) 的持续正气压 (CPAP) 并没有显著减少心血管事件. 然而,良好的CPAP治疗与心血管复发事件的风险较低有关.
科学领域:
- 心脏病学
- 睡眠医学
- 公共卫生
背景情况:
- 持续正气压 (CPAP) 在预防二次心血管疾病中的作用是持续辩论的主题.
- 阻塞性睡眠呼吸暂停 (OSA) 是一种常见的疾病,通常与心血管风险增加有关.
研究的目的:
- 评估CPAP治疗OSA对心血管不良事件发生率的影响.
- 通过随机临床试验的分析来确定CPAP在二次心血管预防中的有效性.
主要方法:
- 在多个数据库 (PubMed,EMBASE,CENTRAL,ClinicalTrials.gov) 进行了系统的搜索,截至2023年6月22日.
- 从相关随机临床试验的个人参与者 (IPD) 数据使用一阶段和两阶段的Cox回归模型进行了分析.
- 用边缘结构模型进行治疗分析来评估CPAP的效果.
主要成果:
- 在4186名参与者的整体分析中,CPAP和常规治疗组之间的重大心脏和脑血管不良事件 (MACCE) 没有显著差异 (HR,1. 01;95% CI,0. 87-1. 17).
- 然而,治疗期间的分析显示,在CPAP坚持良好 (≥4小时/ 天) 的患者中,MACCE的风险显著降低 (HR,0. 69;95% CI,0. 52- 0. 92).
结论:
- 虽然CPAP的整体使用在预防复发性心血管事件方面没有显著的益处,但良好的CPAP治疗与降低风险有关.
- 在OSA患者中,治疗的坚持是有效的二次心血管预防的关键因素.
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