title: Impact of sleep-disordered breathing and efficacy of positive airway pressure on mortality in patients with chronic heart failure and sleep-disordered breathing: a meta-analysis.
abstract: BACKGROUND
  To conduct a meta-analysis to investigate whether sleep-disordered breathing (SDB) is an independent risk factor for mortality and whether positive airway pressure (PAP) decreases mortality in patients with chronic heart failure (HF). The impact of SDB and the effects of PAP on mortality in patients with chronic HF remain unclear.
  
  
  METHODS
  We searched the MEDLINE, EMBASE, and Cochrane databases. Clinical trials that addressed mortality and the effect of PAP on mortality in chronic HF patients with SDB were included in this meta-analysis.
  
  
  RESULTS
  Eleven studies (1,944 participants in total) that addressed mortality in chronic HF patients with SDB were included in this study. Patients with SDB showed a significantly increased mortality risk compared to those without SDB [risk ratio (RR) 1.66 (1.19-2.31)]. In sub-analyses, a significant increase in risk of mortality was observed for central sleep apnea versus no-SDB [RR 1.48 (1.15-1.91)], whereas no significant increase in risk was observed for obstructive sleep apnea versus no-SDB. Five randomized controlled studies (395 participants) that assessed the effect of PAP in chronic HF patients with SDB were analyzed. Adaptive servo-ventilation (ASV) significantly reduced all-cause mortality in chronic HF patients with SDB [RR 0.13 (0.02-0.95)], whereas continuous PAP did not significantly reduce all-cause mortality [RR 0.71 (0.32-1.57)].
  
  
  CONCLUSIONS
  The prevalence of SDB in patients with chronic HF is associated with worse survival, and ASV reduces all-cause mortality in patients with chronic HF concomitant with SDB.
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-0022, Japan, s-nakamura@nms.ac.jp.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Nakamura
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kubota
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takano
authors.forename: Yayoi Tetsuou
authors.initials: YT
authors.lastname: Tsukada
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011175:Positive-Pressure Respiration; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome