title: Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies.
abstract: BACKGROUND
  The association between obstructive sleep apnea (OSA) and the incidence of cardiovascular disease (CVD) has been examined in many studies. However, the findings are not entirely consistent across studies. Our goal was to evaluate the association between OSA and risk of CVD and all-cause mortality by performing a meta-analysis of prospective cohort studies.
  
  
  METHODS
  We used generalized least squares regression models to estimate the dose-response relationship. Heterogeneity, subgroup, and sensitivity analyses and publication bias were performed.
  
  
  RESULTS
  Twelve prospective cohort studies involving 25,760 participants were included in the meta-analysis. The overall combined relative risks for individuals with severe OSA compared with individuals with an AHI of <5 were 1.79 (95% confidence interval [CI]: 1.47 to 2.18) for CVD, 1.21 (95% CI: 0.75 to 1.96) for incident fatal and non-fatal coronary heart disease, 2.15 (95% CI: 1.42 to 3.24) for incident fatal and non-fatal stroke, and 1.92 (95% CI: 1.38 to 2.69) for deaths from all-causes. A positive association with CVD was observed for moderate OSA but not for mild OSA. The results of the dose-response relationship indicated that per 10-unit increase in the apnea-hypopnea index was associated with a 17% greater risk of CVD in the general population.
  
  
  CONCLUSIONS
  This meta-analysis of prospective cohort studies suggests that severe OSA significantly increases CVD risk, stroke, and all-cause mortality. A positive association with CVD was observed for moderate OSA but not for mild OSA.
authors.affiliation: Department of Maternal and Child Health Care, School of Public Health, Shandong University, Jinan, China; Department of Nutrition and Food Hygiene and Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.forename: Yingying
authors.initials: Y
authors.lastname: Ouyang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.forename: Liegang
authors.initials: L
authors.lastname: Liu
authors.forename: Yanping
authors.initials: Y
authors.lastname: Bi
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality*; D015331:Cohort Studies; D006801:Humans; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000401:mortality*
keywords: Cardiovascular disease; Meta-analysis; Obstructive sleep apnea