Why carry out this study?
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Similar to diabetes mellitus, obstructive sleep apnea (OSA) is also known to be a risk factor for cardiovascular diseases. |
However, no study has yet systematically assessed the cardiovascular outcomes in patients with co-existing diabetes mellitus and OSA following coronary angioplasty. |
What was learned from the study?
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OSA was associated with a significant increase in all-cause mortality and major adverse cardiac events post coronary intervention in these patients with diabetes mellitus. |
Therefore, special care and continuous follow-up might be required for patients with diabetes mellitus with associated OSA following percutaneous coronary intervention. |
Introduction
Methods
Data Sources
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MEDLINE
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Cochrane Central
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EMBASE
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Web of Science
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Google Scholar
Searched Terms and Search Strategies
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Obstructive sleep apnea, diabetes mellitus, percutaneous coronary intervention
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Obstructive sleep apnea and percutaneous coronary intervention
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Obstructive sleep apnea, type 2 diabetes mellitus, percutaneous coronary intervention
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Obstructive sleep apnea, diabetes mellitus, coronary angioplasty
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Obstructive sleep apnea, diabetes mellitus, coronary revascularization
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Obstructive sleep apnea, coronary angioplasty
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Obstructive sleep apnea, diabetes mellitus, PCI
Inclusion and Exclusion Criteria
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Patients with T2DM with OSA who have undergone PCI.
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Post-PCI cardiovascular outcomes were reported.
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English publications.
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Patients with T2DM without OSA.
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Post-interventional cardiovascular outcomes were not reported.
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Repeated studies.
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Non-English publications.
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Literature reviews, meta-analyses and systematic reviews as well as case studies.
Outcomes
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Major adverse cerebrovascular and cardiac events (MACCEs), defined as the total number of deaths, re-infarction, revascularization, and stroke
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Major adverse cardiac events (MACEs), defined as the total number of deaths, re-infarction, and revascularization
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Cardiac death
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All-cause mortality
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Re-infarction
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Stroke
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Target vessel revascularization (TVR)
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Target lesion revascularization (TLR)
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Hospitalization for heart failure.
Studies | Outcomes reported | Approximate mean follow-up time period | Treatment strategy |
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Fan [8] | MACCE, cardiovascular death, MI, stroke, hospitalization for unstable angina, hospitalization for heart failure, all-cause mortality, TVR, TLR | 1 year | PCI or CABG |
Lee [9] | Death, re-infarction, stroke, TVR, admission due to heart failure, major adverse events | 18 months | PCI |
Lee [10] | MI, stroke, revascularization, stent thrombosis, MACCE, cardiovascular death, all-cause mortality | 1.9 years | PCI |
Loo [11] | MI, revascularization, stroke, hospitalization for heart failure, cardiac death, MACCE | 24 months | PCI |
Meng [12] | MACEs, cardiac death, heart failure, TVR, stroke | 1 year | PCI |
Nakashima [13] | TVR, re-infarction, MACEs | 4 years | PCI |
Wu [14] | Revascularization, TLR, TVR, MI, stroke, death, MACE, MACCE | 1 and 5 years | PCI |
Yumino [15] | TVR, cardiac death, MACEs | 8 months | PCI |
Data Extraction and Quality Assessment
Statistical Analysis
Compliance with Ethical Guidelines
Results
Search Outcomes
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Involved participants did not undergo PCI (n = 7).
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Post-interventional outcomes were not reported (n = 3).
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Non-English publications (n = 4).
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Case studies (n = 6).
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Literature review (n = 1).
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Systematic reviews and meta-analyses (n = 3).
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Repeated studies (n = 60).
Main and Baseline Features
Studies | Type of study | Year of participants’ enrollment | No. of patients with T2DM with OSA (n) | No. of patients with T2DM without OSA (n) | NOS grade |
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Fan [8] | Prospective | 2015–2017 | 121 | 127 | B |
Lee [9] | Prospective | 2007–2008 | 21 | 21 | B |
Lee [10] | Prospective | 2011–2014 | 271 | 284 | B |
Loo [11] | Prospective | 2011–2012 | 9 | 8 | B |
Meng [12] | OS | 2008 | 19 | 11 | B |
Nakashima [13] | OS | 2003–2009 | 45 | 51 | B |
Wu [14] | Retrospective | 2002–2012 | 100 | 33 | B |
Yumino [15] | OS | 28 | 19 | B | |
Total no. of participants with T2DM (n) | 614 | 554 |
Studies | Age (years) | Male (%) | HBP (%) | DYS (%) | CS (%) | DM (%) |
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OSA/NOSA | OSA/NOSA | OSA/NOSA | OSA/NOSA | OSA/NOSA | OSA/NOSA | |
Fan [8] | 57.7/57.2 | 84.9/80.3 | 68.2/63.6 | 26.6/25.7 | 50.1/50.9 | 100/100 |
Lee [9] | 55.2/50.9 | 97.7/98.4 | 56.8/49.2 | 88.6/80.3 | 54.6/60.7 | 100/100 |
Lee [10] | 59.0/57.5 | 88.1/82.9 | 68.0/54.0 | 60.1/58.7 | 35.4/35.6 | 100/100 |
Loo [11] | 56.7/52.8 | 75.0/93.2 | 66.7/38.6 | 87.5/70.5 | 16.7/63.6 | 100/100 |
Meng [12] | 66.5/66.8 | 70.7/66.7 | 75.7/79.2 | 68.9/66.7 | 36.5/31.3 | 100/100 |
Nakashima [13] | 71.0/65.0 | 77.0/73.0 | 63.0/56.0 | 56.0/55.0 | 32.0/45.0 | 100/100 |
Wu [14] | 55.0/55.0 | 84.2/83.2 | 73.8/70.5 | 44.6/40.0 | 24.6/23.2 | 100/100 |
Yumino [15] | 66.0/65.0 | 84.0/68.0 | 78.0/79.0 | 84.0/53.0 | 63.0/58.0 | 100/100 |
Results of this Analysis
Outcomes | OR with 95% CI | P value | I2 value (%) |
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Major adverse cardiovascular and cerebrovascular events (MACCEs) | 1.38 [0.97–1.98] | 0.07 | 0 |
Major adverse cardiac events (MACEs) | 2.28 [1.24–4.18] | 0.008 | 0 |
Cardiac death | 1.79 [0.77–4.16] | 0.18 | 0 |
All-cause mortality | 1.95 [1.08–3.54] | 0.03 | 0 |
Hospitalization for heart failure | 1.99 [0.43–9.25] | 0.38 | 0 |
Re-infarction | 1.52 [0.85–2.70] | 0.16 | 0 |
Stroke | 1.81 [0.81–4.08] | 0.15 | 0 |
Target vessel revascularization (TVR) | 1.54 [0.98–2.42] | 0.06 | 0 |
Target lesion revascularization (TLR) | 1.32 [0.80–2.18] | 0.28 | 0 |