Impact of Continuous Positive Airway Pressure Treatment on Left Ventricular Ejection Fraction in Patients with Obstructive Sleep Apnea: A Meta-Analysis of Randomized Controlled Trials

<div><p>Background</p><p>It has been known for a long time that obstructive sleep apnea (OSA) is associated with a decreased left ventricular ejection fraction (LVEF). Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; however, it is unknown whether or not CPAP treatment will improve the LVEF. The aim of the current study was to assess whether or not CPAP treatment improves the LVEF. A meta-analysis was conducted to determine the effect of CPAP treatment on the LVEF among patients with OSA.</p><p>Methods</p><p>A literature search of PubMed, the Web of Science, and Cochrane Collaboration’s database were utilized to identify eligible reports for this trial. Ten randomized controlled trails were examined and the meta-analysis was performed using STATA 11.</p><p>Results</p><p>A significant improvement in the LVEF was observed after CPAP treatment (weighted mean difference(WMD) = 3.59, 95% CI = 1.74–5.44; P<0.001). Subgroup analysis revealed that patients with OSA and heart failure had a significant improvement in the LVEF after CPAP treatment (WMD = 5.18, 95% CI = 3.27–7.08; P<0.001); however, the LVEF of patients with OSA only increased 1.11% and there was no statistical significance (WMD = 1.11, 95% CI = −1.13–3.35; P = 0.331). Furthermore, based on univariate meta-regression analysis, only the baseline AHI had a statistically significant correlation with the LVEF.</p><p>Conclusions</p><p>Our meta-analysis supports the notion that CPAP may improve the LVEF among patients with OSA.</p></div

The patient characteristics of the 10 included studies.

<p>BMI: body mass index; AHI: apnea-hypopnea index; SBP: systolic blood pressure; DBP: diastolic blood pressure; LVEF: left ventricular ejection fraction; NR: not reported.</p

Characteristics of 10 studies included in the meta-analysis.

<p>OSA: obstructive sleep apnea; HF: heart failure; NR: not reported.</p

The results of subgroup analysis.

<p>OSA: obstructive sleep apnea; HF: heart failure; AHI: apnea-hypopnea index.</p

Findings of Network Meta-Analyses, Showing the OR Comparing Drugs (95% Credible Interval).

<p>Comparisons between drugs should be read from left to right, and the estimate is in the cell in common between the column-defining treatment and the row-defining treatment. For both outcomes, ORs <1 favor the column-defining treatment. To obtain ORs for comparisons in the opposite direction, reciprocals should be taken. OR indicates odds ratio.</p

The Risk of Metabolic Syndrome in Patients with Rheumatoid Arthritis: A Meta-Analysis of Observational Studies

<div><p>Background</p><p>Observational studies suggest an association between the incidence of rheumatoid arthritis (RA) and the prevalence of metabolic syndrome (MetS). However, the relationship between RA and MetS is controversial and research in this area is currently lacking.</p> <p>Objective</p><p>The aim of this study was to assess whether the prevalence of MetS was higher in a group of RA patients compared to subjects without RA.</p> <p>Design</p><p>A PubMed database search was conducted during April 2013 to identify observational studies of RA and risk of MetS. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the study design, the characteristics of the study participants, exposure and outcome assessments, and the method used to control for potential confounding factors. A random-effects model was used for the risk estimates.</p> <p>Results</p><p>Our meta-analysis of four cross-sectional controlled studies plus eight case-control studies involving a total of 2283 cases and 4403 controls identified a significant association between RA and risk of MetS, with an overall OR of 1.24 (95% CI, 1.03-1.50).</p> <p>Conclusion</p><p>This meta-analysis provides further evidence supporting patients with RA have a higher prevalence of MetS than subjects without RA. In addition, the geographic region of the population and the criteria used for MetS diagnosis could influence the association. However, these observations would need to be evaluated using prospective, randomized studies.</p> </div

Odds ratios and 95 % confidence intervals (CIs) of individual studies and of pooled data for the affect factor by different evaluate standard of Metabolic Syndrome.

<p>Odds ratios and 95 % confidence intervals (CIs) of individual studies and of pooled data for the affect factor by different evaluate standard of Metabolic Syndrome.</p

Prevalence, Incidence, and Mortality of Stroke in the Chinese Island Populations: A Systematic Review

<div><p>Background</p><p>In China, there are 2.5 million new stroke cases each year and 7.5 million stroke survivors. However, stroke incidence in some island populations is obviously lower compared with inland regions, perhaps due to differences in diet and lifestyle. As the lifestyle in China has changed significantly, along with dramatic transformations in social, economic and environmental conditions, such changes have also been seen in island regions. Thus, we analyzed stroke in the Chinese island regions over the past 30 years.</p><p>Methods</p><p>We conducted a systematic review to identify reliable and comparable epidemiologic evidence about stroke in the Chinese island regions between 1980 and 2013. Two authors independently assessed the eligibility and the quality of the articles and disagreement was resolved by discussion. Owing to the great heterogeneity among individual study estimates, a random-effects or fixed-effects model was used to incorporate the heterogeneity among records into a pooled estimate for age-standardized rates. Age-standardized rates were calculated by the direct method with the 2000 world population if included records provided the necessary information.</p><p>Results</p><p>During the past three decades, the overall pooled age-standardized prevalence of stroke is 6.17 per 1000 (95% CI 4.56–7.78), an increase from 5.54 per 1000 (95% CI 3.88–7.20) prior to 2000 to 8.34 per 1000 (95% CI 5.98–10.69) after 2000. However, this difference was not found to be statistically significant. The overall pooled age-standardized incidence of stroke is 120.42 per 100,000 person years (95% CI 26.17–214.67). Between 1982 and 2008, the incidence of stroke increased and mortality declined over time.</p><p>Conclusions</p><p>Effective intervention and specific policy recommendations on stroke prevention should be required, and formulated in a timely fashion to effectively curb the increased trend of stroke in Chinese island regions.</p></div

Annual age-standardized incidence of stroke per 100,000 person-years in selected studies (adjusted to the WHO world population).

<p>Studies are arranged in ascending order of research.</p

Pooled age-standardized prevalence of stroke (per 1000) in selected studies by different periods.

<p>Pooled age-standardized prevalence of stroke (per 1000) in selected studies by different periods.</p