Table 1.
The study characteristics of sleep disorders in patients with CVD.
| No. | First author Publication year |
Country | Study design | CVD | Sleep disorders | Sample /Age (years) |
Sleep measurement | Main findings | Study quality assessment |
|---|---|---|---|---|---|---|---|---|---|
| Coronary artery disease | |||||||||
| 1 | Alonderis2020 [25] | Lithuania | Cross-sectional study | CAD with LVEF≥ 50% | SA | N = 450 | Polysomnography | Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. | Combie high quality |
| AMI+SA+ | |||||||||
| N = 156/59.4 ± 9.2yrs | |||||||||
| AMI+SA- | |||||||||
| N = 294/56.1 ± 9.1yrs | |||||||||
| 2 | Andrechuk2015 [26] | Brazil | Cross-sectional study | AMI | OSA | N = 113/59.7 ± 12.3 yrs | Berlin Questionnaire | The high prevalence of obstructive sleep apnoea was 60.2% | Combie high quality |
| 3 | Araújo2009 [31] | Brazil | Cross-sectional study | CAD | OSA | N = 53 | Polysomnography | OSA was not related to myocardial ischemia, heart rate variability or arrhythmias in patients with SCAD. | Combie high quality |
| Control | |||||||||
| n = 23/57.47 ± 10.59yrs | |||||||||
| Apnea | |||||||||
| n = 30/59.00 ± 10.42yrs | |||||||||
| 4 | Aronson2014 [27] | Israel | Prospective cohort study | AMI | SDB | N = 180 | Watch-PAT 100 | A high prevalence of previously undiagnosed SDB among patients with AMI. SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure. SDB was not associated with adverse clinical outcomes. | NOS high quality |
| AMI + SDB | |||||||||
| N = 116/59±9yrs | |||||||||
| AMI non-SDB | |||||||||
| N = 64/56 ± 11yrs | |||||||||
| 5 | Assari2013 [35] | Iran | Cross-sectional study | CAD | Sleep quality | N = 717/57.7 ± 11.7yrs | PSQI | Among female patients with CAD, low education and income were associated with poor sleep quality. | Combie high quality |
| 6 | Barcelo2016 [39] | Spain | RCT | ACS | OSA | N = 312/61.2 ± 10.3yrs | Polygraph | In patients with ACS, elevated plasma levels of PlGF are associated with the presence of OSA and with adverse outcomes during short-term follow up. | CoB |
| Controls | |||||||||
| N = 226/56.5 ± 11.5yrs | |||||||||
| OSA | |||||||||
| N = 312/61.2 ± 10.3yrs | |||||||||
| 7 | Barger2017 [29] | 36 countries | Prospective cohort study | ACS | Short sleep duration OSA |
N = 12924/64years | Berlin questionnaire a sleep survey | Short sleep duration, and OSA, are under-recognized as predictors of adverse outcomes after acute coronary syndrome. | NOS high quality |
| No OSA | |||||||||
| N = 8084/65 (60,71) | |||||||||
| OSA | |||||||||
| N = 4840/63 (57, 69) | |||||||||
| 8 | Buchner2015 [28] | Germany | Prospective cohort study | AMI | SDB | N = 54 | Polysomnography | SDB may contribute to enlargement of the right heart after AMI. | NOS high quality |
| AMI + SDB+ | |||||||||
| N = 29/55 ± 10yrs | |||||||||
| AMI + SDB- | |||||||||
| N = 25/53 ± 10yrs | |||||||||
| 9 | Cai 2022 [33] | China | Cross-sectional study | CAD | Sleep quality | N = 84 | PSQI | MDD may be responsible for poor sleep quality, in patients with CHD, treatment for depressive symptoms may also improve CHD prognosis. | Combie high quality |
| CHD MDD (+) | |||||||||
| 58.46 ± 6.12yrs | |||||||||
| CHD MDD (−) | |||||||||
| 57.68 ± 5.50yrs | |||||||||
| 10 | Clark2014 [36] | Sweden | Prospective cohort study | AMI | Sleep impairment | N = 1588/60±7yrs | Karolina Sleep Questionnaire | In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events; In men, a strong effect on case fatality was observed in regard to impaired awakening | NOS high quality |
| Women | |||||||||
| No disturbed sleep | |||||||||
| N = 418/62±7yrs | |||||||||
| Disturbed sleep | |||||||||
| N = 78/61±7yrs | |||||||||
| Men | |||||||||
| No disturbed sleep | |||||||||
| N = 1008/59±7yrs | |||||||||
| Disturbed sleep | |||||||||
| N = 77/59±7yrs | |||||||||
| 11 | Correia2012 [30] | Brazil | Prospective cohort study | UA NSTEMI |
OSA | N = 168/70 ± 12yrs | Berlin Questionnaire | During a median hospitalization of 8 days, the incidence of cardiovascular events was 13%. Incidence of the primary endpoint was 18% in individuals with high probability of OSA. | NOS high quality |
| Low OSA probability | |||||||||
| N = 45/69 ± 14yrs | |||||||||
| High OSA probability | |||||||||
| N = 123/71 ± 12yrs | |||||||||
| 12 | Feng2022 [43] | Canada | Prospective cohort study | CAD | Sleep quality | N = 113/63.7 ± 6.4yrs | PSQI | A marker of late-stage lipid peroxidation is elevated in CAD patients with poor sleep and associated with daily disturbances, but not with other factors or with sleep quality and its factors after exercise intervention. | NOS high quality |
| Normal sleep quality | |||||||||
| N = 54/64.8 ± 6.6yrs | |||||||||
| Poor sleep quality | |||||||||
| N = 59/62.6 ± 6.1yrs | |||||||||
| 13 | Huang2020 [41] | China | Cross-sectional study | CAD | OSA | N = 1243 | Overnight portable respiratory monitoring | Elevated levels of MHR were independently associated with a higher likelihood of OSA in patients with CAD. | Combie high quality |
| MHR Quartile 1 | |||||||||
| N = 311/63.3 ± 9.1yrs | |||||||||
| MHR Quartile 2 | |||||||||
| N = 311/62.6 ± 9.5yrs | |||||||||
| MHR Quartile 3 | |||||||||
| N = 311/62.6 ± 13.0yrs | |||||||||
| MHR Quartile 4 | |||||||||
| N = 310/60.2 ± 10.8yrs | |||||||||
| 14 | Juskiene2018 [32] | Lithuania | Cross-sectional study | CAD | Sleep quality OSA |
N = 879/58 ± 9 yrs | Polysomnography PSQI |
In CAD patients, type D personality and NA are associated with worse subjective sleep quality and this association is mediated by depression and anxiety symptoms irrespective of OSA presence. | Combie high quality |
| Men | |||||||||
| No OSA | |||||||||
| N = 374/55.0 ± 9.2yrs | |||||||||
| OSA | |||||||||
| N = 286/59.0 ± 8.8yrs | |||||||||
| Women | |||||||||
| No OSA | |||||||||
| N = 156/60.5 ± 7.9yrs | |||||||||
| OSA | |||||||||
| N = 63/63 ± 6.9yrs | |||||||||
| 15 | Katsumata2020 [42] | Japan | Cross-sectional study | CAD | OSA | N = 178 | Polysomnography | Elevated SNX16-Ab level associated with the history of CAD. | Combie high quality |
| Healthy adults | |||||||||
| N = 64/42.5yrs | |||||||||
| OSA N = 82/59yrs | |||||||||
| ACS N = 96/67yrs | |||||||||
| 16 | Kazukauskiene2022 [37] | Lithuania | Cross-sectional study | CAD | OSA | N = 328/57 ± 10yrs | Polysomnography | CAD males with OSA and clinically elevated NT-proBNP levels experienced inferior psychomotor performance | Combie high quality |
| OSA | |||||||||
| N = 75/59.7 ± 8.1yrs | |||||||||
| No OSA | |||||||||
| N = 253/56.1 ± 10.1yrs | |||||||||
| 17 | Khan2014 [34] | Pakistan | Cross-sectional study | CAD | OSA | N = 400 | Berlin questionnaire | A significant proportion of CAD patients are at high risk of OSA in Pakistan. Moreover, OSA is also associated with greater levels of anxiety in CAD patients | Combie high quality |
| CAD | |||||||||
| N = 200/55.07 ± 6.88yrs | |||||||||
| Healthy | |||||||||
| N = 200/55.19 ± 6.69yrs | |||||||||
| 18 | Labeix2022 [46] | Sweden | RCT | CAD | OSA | N = 45 | PSQI | A specific IMT during cardiac rehabilitation contributes to reduce significantly AHI in CAD patients with moderate OSA. | CoB |
| Control | |||||||||
| N = 23/59.3 ± 10.3yrs | |||||||||
| IMT | |||||||||
| N = 22/61.0 ± 8.4yrs | |||||||||
| 19 | Li2020 [44] | China | Cross-sectional study | CAD | OSA | N = 154/54.9 ± 9.4yrs | Portable cardiorespiratory monitoring device | Plasma CTRP9 levels were independently related to the prevalence of moderate/severe OSA in patients with CAD. | Combie high quality |
| Moderate/severe OSA | |||||||||
| N = 89/54.4 ± 8.8yrs | |||||||||
| No/mild OSA | |||||||||
| N = 65/55.1 ± 10.3yrs | |||||||||
| 20 | Milleron2004 [45] | France | Long-term prospective cohort study | CAD | OSA | N = 54/57.3 ± 10.1yrs | Polysomnography | The treatment of OSA in CAD patients is associated with a decrease in the occurrence of new cardiovascular events, and an increase in the time to such events. | NOS high quality |
| OSA-treated | |||||||||
| N = 25/57.7 ± 10.1yrs | |||||||||
| OSA-untreated | |||||||||
| N = 29/57.0 ± 10.2yrs | |||||||||
| 21 | Strehmel2016 [38] | Germany | Cross-sectional study | CAD | OSA | N = 41 | Polysomnography | CPAP has the potential to normalize elevated NT-proBNP serum levels in patients with severe OSA and coexisting CAD. Levels of NT-proBNP and hs-TropT correlated with AHI and oxygen desaturation | Combie high quality |
| OSA + CAD | |||||||||
| N = 21/61 ± 11yrs | |||||||||
| OSA | |||||||||
| N = 20/54 ± 12yrs | |||||||||
| 22 | Thunström2015 [40] | Sweden | Cross-sectional study | CAD | OSA | N = 439 | Cardiorespiratory Polygraphy | Obstructive sleep apnea with oxygen desaturation index ≥5 was independently associated with increased inflammatory activity in this nonobese coronary artery disease cohort. | Combie high quality |
| CAD + nonobese + OSA | |||||||||
| N = 234/65.3 ± 7.1yrs | |||||||||
| CAD + nonobese + nonOSA | |||||||||
| N = 95/61.4 ± 9.5yrs | |||||||||
| CAD + obese + OSA | |||||||||
| N = 110/62.9 ± 8.6yrs | |||||||||
| Hypertension | |||||||||
| 1 | Akintunde2014 [53] | Nigeria | Cross-sectional study | HTN | OSA | N = 104 | Berlin questionnaire | OSA is associated with significant additional left ventricular changes in hypertensive subjects. | Combie high quality |
| Low risk of OSA | |||||||||
| N = 49/58.8 ± 12.6 | |||||||||
| High risk of OSA | |||||||||
| N = 55/58.6 ± 11.2 | |||||||||
| 2 | Ayanaw2022 [47] | Italy | Cross-sectional study | HTN | Sleep quality | N = 563/65yrs | PSQI | More than one-third of the study participants had poor sleep quality. | Combie high quality |
| 3 | Bacci2017 [54] | Brazil | Cross-sectional study | HTN | OSA Sleep quality |
N = 43/52.9 ± 14.5yrs | PSQI ESS BQ | Patients at high risk for OSAHS had poor sleep quality and high levels of DBP. | Combie high quality |
| 4 | Bengtsson Boström2010 [55] | Sweden | Cross-sectional study | HTN | OSA | N = 170 | Polysomnography | Hypertensive men carrying the Arg389Arg genotype had higher crude and age-adjusted AHI than carriers of the Arg389Gly/Gly389Gly genotypes | Combie mid quality |
| Normotension | |||||||||
| N = 96/60 ± 6.3yrs | |||||||||
| HTN | |||||||||
| N = 74/62 ± 6.2yrs | |||||||||
| 5 | Cai2017 [50] | China | Cross-sectional study | HTN | OSA | N = 971 | Polysomnography | In a Chinese hypertensive population, OSA prevalence is strikingly high. Hypertensive subjects with the most severe OSA are at greater cardiovascular risk. | Combie high quality |
| Without OSA | |||||||||
| N = 286/56.5 ± 13.3yrs | |||||||||
| With OSA | |||||||||
| N = 685/59.3 ± 11.7yrs | |||||||||
| 6 | Cai2022 [57] | China | Single-center, observational, Retrospective cohort study |
HTN | OSA | N = 2067/49.51 ± 10.73 yrs | Polysomnography | There was a positive association between CMI levels and the risk of new-onset CVD in patients with hypertension and OSA. | NOS high quality |
| CMI˂0.73 | |||||||||
| 52.13 ± 11.41yrs | |||||||||
| 0.73–1.21 | |||||||||
| 49.05 ± 10.87yrs | |||||||||
| ≥1.21 | |||||||||
| 47.52 ± 9.43yrs | |||||||||
| 7 | Chang2013 [59] | China | Retrospective cohort study | HTN | Insomnia | N = 4063 | ICD-9-CM | The use of bisoprolol and atenolol was associated with the lowest risk of insomnia in elderly patients, as compared to propranolol. β-blockers with high selectivity in β1-receptors and/or low lipophilicity were associated with a lower risk of insomnia | NOS high quality |
| Propranolol user | |||||||||
| N = 760/73.3 ± 6.3yrs | |||||||||
| Non-propranolol user | |||||||||
| N = 3303/72.3 ± 6.1yrs | |||||||||
| 8 | Chaudhary2023 [51] | India | Cross-sectional study | HTN | OSA | N = 179/52.07 ± 11.40yrs | Polysomnography | More than half (53.1%) of the patients enrolled in the study had OSA. More than half of our hypertensive patients had OSA. These two conditions often co-exist and are known as a dangerous pair. | Combie high quality |
| 9 | Chen2020 [64] | China | RCT | HTN | OSA | N = 60/18–75yrs | Polysomnography | The CPAP treatment did not show significant ambulatory BP lowering effect in patients with moderate-severe OSAS and nocturnal hypertension. However, it may be effective in lowering daytime BP in patients with a faster pulse rate. | CoB |
| 10 | Ching2023 [52] | Malaysia | Cross-sectional study | HTN | OSA | N = 410/56.4 ± 11.3yrs | Polysomnography | The prevalence of probable OSA among patients with hypertension was 54.4%. | Combie high quality |
| Probable OSA | |||||||||
| N = 223/58.3 ± 10.6yrs | |||||||||
| Non-probable OSA | |||||||||
| N = 187/54.2 ± 11.7yrs | |||||||||
| 11 | Friedman2010 [48] | Canada | Case-control study | Drug-resistant hypertension | Sleep quality | N = 156 | Polysomnography | Compared to subjects with CH or normotension, those with RH have shorter total and REM sleep times and lower sleep efficiency independently of OSA. These data suggest that reduced sleep time may contribute to the severity of hypertension | NOS high quality |
| Normotension | |||||||||
| N = 40/52.2 ± 9.9yrs | |||||||||
| Control HTN | |||||||||
| N = 54/58.5 ± 11.3yrs | |||||||||
| Resistant HTN | |||||||||
| N = 62/58.9 ± 10.8yrs | |||||||||
| 12 | Gaddam2010 [62] | USA | Prospective cohort study | Resistant hypertension | OSA | N = 12/56.5 ± 6.5yrs | Polysomnography | This study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. |
NOS mid quality |
| 13 | Gonzaga2010 [61] | USA | Retrospective study | HTN | OSA | N = 109/55.9 ± 9.1yrs | Polysomnography | Severity of OSA was greater in those patients with hyperaldosteronism and related to the degree of aldosterone excess. | NOS mid quality |
| High aldosterone level | |||||||||
| N = 31/56.4 ± 7.8 | |||||||||
| Normal aldosterone level | |||||||||
| N = 78/55.7 ± 9.7 | |||||||||
| 14 | Jafari2013 [56] | USA | Cross-sectional study | HTN | OSA | N = 95 | Polysomnography | These data show that patients with OSA and hypertension have marked impairment of FMD, independent of hypoxia exposure, which is associated with increased sEng. | Combie mid quality |
| Non-OSA | |||||||||
| Normotension | |||||||||
| N = 19/47.5 ± 2.1yrs | |||||||||
| HTN | |||||||||
| N = 13/45.7 ± 2.3yrs | |||||||||
| OSA | |||||||||
| Normotension | |||||||||
| N = 27/47.9 ± 2.2yrs | |||||||||
| HTN | |||||||||
| N = 36/56.1 ± 1.4yrs | |||||||||
| 15 | Li2021 [49] | Germany | Prospective cohort study | HTN | Sleep quality | N = 1959/25–65 yrs | A three-point Likert response scale | Our findings add a new piece of evidence that work stress together with impaired sleep increase risk of coronary and cardiovascular mortality in hypertensive workers. | NOS high quality |
| 16 | Lui2021 [63] | China | RCT | HTN | OSA | N = 92/53.2 ± 8.7yrs | Polysomnography | In a cohort with OSA and multiple cardiovascular risk factors including difficult-to-control hypertension, short-term CPAP treatment improved ambulatory BP, and alleviated subclinical myocardial injury and strain. | CoB |
| CPAP | |||||||||
| N = 46/52.5 ± 9.0yrs | |||||||||
| Control | |||||||||
| N = 46/53.9 ± 8.4yrs | |||||||||
| 17 | Martínez-García 2013 [65] |
Spain | RCT | Resistant hypertension | OSA | N = 194/56.0 ± 9.5yrs | Respiratory polygraphy | Among patients with OSA and resistant hypertension, CPAP treatment for 12 weeks compared with control resulted in a decrease in 24-h mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern. | CoB |
| Control | |||||||||
| N = 96/58.2 ± 9.6yrs | |||||||||
| CPAP | |||||||||
| N = 98/57.8 ± 9.5yrs | |||||||||
| 18 | Wolf2016 [60] | Poland | Cross-sectional study | HTN | OSA | N = 88 | Polysomnography | Beta-blockers do not potentiate apnea-induced HR decelerations, attenuate apnea-induced increases in heart rate and do not influence incidence of ectopies and conduction abnormalities in patients with hypertension and moderate-to-severe, untreated OSA | Combie high quality |
| BB− | |||||||||
| N = 32/55 (46–63)yrs | |||||||||
| BB+ | |||||||||
| N = 56/57.5 (54–62)yrs | |||||||||
| 19 | Zamarrón2008 [58] | Spain | Cross-sectional study | HTN | OSA | N = 96/53.3 ± 8.2yrs | Polysomnography | OSAS patients presented higher circulating levels of PAI than the control group, which was even greater when patients had associated hypertension. | Combie high quality |
| Control | |||||||||
| N = 32/48.2(43.6, 52.9)yrs | |||||||||
| OSAS | |||||||||
| N = 32/52.7(49.9,55.4)yrs | |||||||||
| OSAS + HT | |||||||||
| N = 32/54.1 (50.6, 57.6)yrs | |||||||||
| Heart failure | |||||||||
| 1 | Abdelbasset2020 [79] | Egypt | Pilot study | HF | Sleep disturbance | N = 8/69.4 ± 4.2 yrs | PSQI | Low-intensity exercise program five sessions weekly for four weeks. low-intensity aerobic exercise may improve the quality of sleep and ventilator efficiency in elderly HF patients. | MINORS mid quality |
| 2 | Alosco2013 [68] | USA | Cross-sectional study | HF | Sleep quality | N = 53/69.81 ± 8.79yrs | PSQI | 75.5% of HF patients reported impaired sleep. Decreased cerebral perfusion and greater WMH may contribute to sleep difficulties in HF. | Combie high quality |
| 3 | Arzt2017 [69] | Germany | Cross-sectional study | HFrEF | SDB | N = 1557 | Polysomnography | Prevalence of SDB in HFpEF, HFmrEF and HFrEF (36%, 41% and 48%, respectively). The prevalence of coexisting OSA-CSA, OSA and CSA were 40%, 29% and 31% in patients with HFrEF respectively. |
Combie high quality |
| OSA | |||||||||
| N = 452/66 ± 11yrs | |||||||||
| OSA-CSA | |||||||||
| N = 624/69 ± 10yrs | |||||||||
| CSA | |||||||||
| N = 481/69 ± 10yrs | |||||||||
| 4 | Avci2021 [70] | Turkey | Cross-sectional study | HF | Sleep quality | N = 95/75.44 ± 6.36yrs | PSQI | Elderly patients with HF experienced significant sleep problems and that their sleep quality decreased as the depression symptom levels increased. | Combie high quality |
| 5 | Awotidebe2017 [66] | Nigeria | Case-control study | CHF | Sleep quality | N = 100 | Pittsburgh Sleep | Patients with heart failure demonstrated lower functional capacity and poorer sleep quality. | NOS high quality |
| Patient | |||||||||
| N = 50/57.8 ± 8.9yrs | |||||||||
| Control | |||||||||
| N = 50/54.9 ± 7.9yrs | |||||||||
| 6 | Beres2022 [80] | Romania | Prospective, mono-center, cohort study | HF | CSA | N = 36/65.7 ± 10.8yrs | Polysomnography | The association of PAP therapy with drug therapy in patients with HFrEF and CSAS improves hemodynamic parameters and quality of life. | NOS mid quality |
| 7 | Bhalla2020 [71] | India | Prospective cohort study | CHF | OSA | N = 77/30–80 yrs | Polysomnography | The prevalence of OSA in CHF was 50.6%. Predictors of OSA in CHF were left ventricular ejection fraction (LVEF) 20%–30% and NYHA class 2. | NOS high quality |
| 8 | Bitter2011 [67] | Germany | Prospective cohort study | CHF | OSA | N = 255 | Cardiorespiratory polygraphy | In patients with CHF, CSA and OSA are independently associated with an increased risk for ventricular arrhythmias and appropriate cardioverter-defibrillator therapies. | NOS high quality |
| AHI≥5h-1 | |||||||||
| OSA | |||||||||
| N = 82/67.9 (63.9,73.7)yrs | |||||||||
| CSA | |||||||||
| N = 87/68.4 (62.1,72.4)yrs | |||||||||
| noSDB | |||||||||
| N = 86/65.7 (56.5,71.6)yrs | |||||||||
| 9 | Bughin2021 [76] | France | A longitudinal study | HF | Sleep patterns | N = 119/69yrs | PSQI ESS ISI BQ |
CNS drugs intake and decreased total sleep time were independently associated with an increased risk of MACE in patients with HF. | MINORS high quality |
| 10 | Calvin2014 [72] | USA | Prospective cohort study | HF LVEF≤35% | CSA | N = 46 | Polysomnography | Increased LAVI is associated with heightened CO2 chemosensitivity and greater frequency of CSA. | NOS mid quality |
| HF without CSA | |||||||||
| N = 21/59.3 ± 9.9yrs | |||||||||
| HF with CSA | |||||||||
| N = 25/68.5 ± 8.1yrs | |||||||||
| 11 | Calvin2010 [73] | USA | Prospective cohort study | HF | CSA | N = 51 | Polysomnography | In non-anaemic HF patients, advanced HF and hypoxaemia due to CSA may each be independently associated with increased serum EPO concentration. | NOS mid quality |
| Healthy controls | |||||||||
| N = 18/54.7 ± 16.8yrs | |||||||||
| HF without CSA | |||||||||
| N = 15/59.9 ± 12.0yrs | |||||||||
| HF with CSA | |||||||||
| N = 14/65.7 ± 10.7yrs | |||||||||
| 12 | Calvin2011 [74] | USA | Prospective cohort study | HF | CSA | N = 33 | Polysomnography | ANP and BNP concentrations performed similarly for detection of CSA; low concentrations appear associated with low risk for CSA in men. | NOS mid quality |
| HF without CSA | |||||||||
| N = 9/61.1 ± 12.4yrs | |||||||||
| HF with CSA | |||||||||
| N = 24/66.7 ± 9.9yrs | |||||||||
| 13 | Cundrle2018 [77] | USA | Cross-sectional study | HF | CSA | N = 56/65 ± 10yrs | Polysomnography | Low leptin concentration may have utility for the screening of heart failure patients for central sleep apnea. | Combie mid quality |
| CSA | |||||||||
| N = 18/67 ± 10yrs | |||||||||
| Mixed apnea | |||||||||
| N = 15/64 ± 10yrs | |||||||||
| No apnea | |||||||||
| N = 11/59 ± 10yrs | |||||||||
| OSA | |||||||||
| N = 12/68±8yrs | |||||||||
| 14 | Ferreira2020 [75] | Germany | RCT | HF | OSA | N = 749/69 ± 10 yrs | Not mentioned | Three biomarkers added significant prognostic information on top of the best clinical model: soluble suppression of tumorigenicity 2 (primary outcome), Notch-3 (CV and all-cause death), and GDF-15 (all-cause death). | CoB |
| Control | |||||||||
| N = 368/69.1 ± 10.2yrs | |||||||||
| ASV | |||||||||
| N = 381/69.3 ± 9.4yrs | |||||||||
| 15 | Gerçek2022 [78] | Germany | Retrospective study | HF | SDB | N = 146 | Polysomnography | SDB treatment in HF patients with ICD leads to significant improvements in VT burden, ATP and shock therapy, and may even affect survival. | NOS high quality |
| Control | |||||||||
| N = 73/67.67 ± 10.78 yrs | |||||||||
| SDB-treated | |||||||||
| N = 73/67.2 ± 10.10 yrs | |||||||||
| 16 | Redeker2022 [81] | USA | RCT | HF | Insomnia | N = 175/63 ± 12.9 yrs | PSQI | CBT-I produced sustained improvements in insomnia, fatigue, daytime sleepiness, and objectively measured physical function among adults with chronic HF, compared with a robust HF self-management program that included sleep hygiene education. | CoB |
| Healthy sleep | |||||||||
| N = 91/62.0 ± 13.1yrs | |||||||||
| Healthy heart | |||||||||
| N = 84/64.1 ± 12.6yrs | |||||||||
| Cardiac arrhythmia | |||||||||
| 1 | Abumuamar2018 [82] | Canada | Prospective cohort study | AF | OSA | N = 123/63.6 ± 13.3yrs | Polysomnography | OSA was detected in 85% of these patients. | NOS high quality |
| 2 | Abumuamar2019 [91] | Canada | Prospective cohort study | AF | OSA | N = 100/63 ± 13yrs | Polysomnography | There is a significant decrease in atrial and ventricular ectopy count/24 h in patients with AF and OSA at 3 and 6 months of CPAP treatment compared to baseline. | NOS high quality |
| OSA | |||||||||
| N = 85/65 ± 13yrs | |||||||||
| Non-OSA | |||||||||
| N = 15/55 ± 14yrs | |||||||||
| 3 | Albuquerque2012 [83] | USA | Prospective cohort study | AF | SDB | N = 151/69.1 ± 11.7yrs | Polysomnography | The prevalence of SDB in this population was 81.4%. | NOS mid quality |
| No EDS | |||||||||
| N = 98/70.1 ± 1.2yrs | |||||||||
| EDS | |||||||||
| N = 53/67.1 ± 1.6yrs | |||||||||
| 4 | Anter2017 [87] | USA | Cross-sectional study | PAF | OSA | N = 184 | polysomnography or a home sleep apnea testing device | In patients with paroxysmal AF, OSA is associated with structural and functional atrial remodeling and increased incidence of extra-PV triggers. | Combie mid quality |
| (+)OSA(+)PVI(+) Triggers | |||||||||
| N = 43/49 ± 12yrs | |||||||||
| (−)OSA(+)PVI(+) Triggers | |||||||||
| N = 43/54 ± 14yrs | |||||||||
| (−)OSA(+)PVI(−) Triggers | |||||||||
| N = 48/59 ± 12yrs | |||||||||
| (+)OSA(+)PVI(−) Triggers | |||||||||
| N = 50/51 ± 15yrs | |||||||||
| 5 | Bitter2009 [84] | Germany | Cross-sectional study | AF | SDB | N = 150/66.1 ± 1.7yrs | Cardiorespiratory polygraphy | Patients with AFib were found to have not only a high prevalence of obstructive sleep apnea, as has been described previously, but also a high prevalence of CSA/CSR. | Combie mid quality |
| CSA/CSR | |||||||||
| N = 47/64.1 ± 5.0yrs | |||||||||
| OSA | |||||||||
| N = 64/67.4 ± 2.1yrs | |||||||||
| No SDB | |||||||||
| N = 39/65.4 ± 4.8yrs | |||||||||
| 6 | Brgdar2021 [90] | USA | Retrospective study | AF | OSA | N = 156,521 | ICD-10 | Although OSA is highly prevalent in AF patients, inpatient mortality and cardiovascular outcomes such as cardiac arrest, stroke, or major bleeding were similar in AF patients with or without concomitant OSA with no significant differences in length of stay. | NOS high quality |
| Pre-match | |||||||||
| OSA | |||||||||
| N = 23,678/65.18 ± 10yrs | |||||||||
| Non-OSA | |||||||||
| N = 132,843/71.4 ± 13yrs | |||||||||
| Post-match | |||||||||
| OSA | |||||||||
| N = 23,678/65.18 ± 12.7yrs | |||||||||
| Non-OSA | |||||||||
| N = 23,678/65.09 ± 12.7yrs | |||||||||
| 7 | Cang2023 [86] | China | Retrospective cohort study | AF | Sleep quality | N = 416 | Questionnaire Self-reported sleep pattern |
Sleep disorders such as inadequate sleep time (time <7 h or >8 h), insomnia and excessive sleepiness during daytime were associated with a higher risk of recurrence. | NOS high quality |
| Healthy sleep score 0-1 | |||||||||
| N = 20/63.50 ± 7.99yrs | |||||||||
| Healthy sleep score 2-3 | |||||||||
| N = 188/63.65 ± 9.55yrs | |||||||||
| Healthy sleep score 4-5 | |||||||||
| N = 208/63.15 ± 9.72yrs | |||||||||
| 8 | Dalgaard2020 [88] | USA | Retrospective cohort study | AF | OSA | N = 22,760/73.0 (65.0–80.0)yrs | A medical history and prior diagnosis. | Among patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE. | NOS high quality |
| OSA | |||||||||
| N = 4045/68.0 (61.0–75.0)yrs | |||||||||
| No OSA | |||||||||
| N = 18,715/74.0 (66.0–81.0)yrs | |||||||||
| 9 | Kayrak2013 [85] | Turkey | Case-control study | AF | Sleep quality | N = 303 | PSQI | Patients with AF have shorter sleep duration and poor SQ. Maintenance of sinus rhythm after DCC may have a favorable effect on the SQ of patients with AF. Nevertheless, AF is an independent predictor of poor SQ. | NOS high quality |
| AF | |||||||||
| N = 153/63 ± 12yrs | |||||||||
| Control | |||||||||
| N = 150/61 ± 14yrs | |||||||||
| 10 | Tang2009 [89] | China | Prospective cohort study | paroxysmal AF | OSA | N = 178 | Berlin questionnaire | The recurrence rate and incidence of complications did not differ in patients with different risk profiles for OSA. | NOS high quality |
| Low risk of OSA | |||||||||
| N = 74/56 ± 12yrs | |||||||||
| High risk of OSA | |||||||||
| N = 104 58 ± 11yrs | |||||||||
| Other CVD | |||||||||
| 1 | Abe2009 [96] | Japan | Cross-sectional study | HF with MV and/or AV Valve repair surgery |
SAS (OSA, CSA) | N = 150 | Polysomnography | The treatment led to a significant improvement in PCWP and mean PAP, and CSA-AI, improvement of cardiac function with valvular surgery reduces the severity of CSA in HF patients with valvular heart diseases. | Combie high quality |
| mild-to-no SA | |||||||||
| N = 47/66.0 ± 11.4yrs | |||||||||
| SAS | |||||||||
| N = 103/69.5 ± 8.8yrs | |||||||||
| 2 | Amofah2016 [95] | Sweden | Prospective cohort study | SAVR or TAVI surgery | Sleep quality | N = 143/83 ± 2.7yrs | Self-reports actigraphy MISS |
In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase. | NOS high quality |
| SAVR | |||||||||
| N = 78/82 ± 2.0yrs | |||||||||
| TAVI | |||||||||
| N = 65/85 ± 2.8yrs | |||||||||
| 3 | Banno2004 [92] | Japan | Cross-sectional study | Idiopathic cardiomyopathy (DCM, HCM) | SDB | N = 35 | PSG | Of these 35, 16 (80%) of the DCM patients and 7 (47%) of the HCM patients had sleep-disordered breathing. | Combie mid quality |
| DCM | |||||||||
| CSAHS | |||||||||
| N = 10/48.4 ± 14.2yrs | |||||||||
| OSAHS | |||||||||
| N = 6/43.3 ± 9.5yrs | |||||||||
| non-SAHS | |||||||||
| N = 4/47.0 ± 14.0yrs | |||||||||
| HCM | |||||||||
| OSAHS | |||||||||
| N = 7/48.4 ± 8.3yrs | |||||||||
| non-SAHS | |||||||||
| N = 8/47.8 ± 15.7yrs | |||||||||
| 4 | Biener2023 [97] | Germany | Prospective cohort study | Mitral regurgitation Mitral valve repair surgery | SDB | N = 53/76.0 ± 8.5yrs | polygraphy | TMVR may be a suitable therapy not only for MR but also for the accompanying CSA. LAVI may be a useful indicator for CSA in patients with MR. | NOS high quality |
| SDB | |||||||||
| N = 36/75.8 ± 8.1yrs | |||||||||
| No SDB | |||||||||
| N = 17/76.5 ± 9.6yrs | |||||||||
| 5 | Bodez2016 [93] | France | Cross-sectional study | Cardiac Amyloidosis | SDB | N = 70/71 ± 12 yrs | nocturnal polygraphy | In CA population, prevalence of SDB is high (90%) and dominated by the obstructive pattern. | Combie high quality |
| AL | |||||||||
| N = 31/65 ± 12yrs | |||||||||
| m-TTR | |||||||||
| N = 22/71 ± 12yrs | |||||||||
| WT-TTR | |||||||||
| N = 17/81±7yrs | |||||||||
| 6 | Roggenbach2014 [98] | Germany | Prospective cohort study | Elective cardiac surgery | SDB | N = 92/67.5 ± 8.9yrs | Polygraphic recordings | Preoperative SDB were strongly associated with postoperative delirium, and may be a risk factor for postoperative delirium. | NOS mid quality |
| No postoperative delirium | |||||||||
| N = 48/64.5±9yrs | |||||||||
| Postoperative delirium | |||||||||
| N = 44/70.8 ± 7.8yrs | |||||||||
| 7 | Javaherforooshzadeh 2022 [100] |
Iran | Prospective cohort study | cardiac surgery | OSA | N = 306 | STOP-Bang questionnaire | OSA is common in patients undergoing cardiac surgery. Our findings indicate that these patients manifest a higher incidence of postoperative complications compared to those with a lower risk of OSA. | NOS high quality |
| Low risk | |||||||||
| N = 33/54.5 ± 12.9yrs | |||||||||
| Intermediate risk | |||||||||
| N = 100/59.1 ± 10.2yrs | |||||||||
| High risk | |||||||||
| N = 173/60.1 ± 8.6yrs | |||||||||
| 8 | Tafelmeier2019 [99] | Germany | Prospective cohort study | cardiac surgery | SDB | N = 141/68±9yrs | Polysomnography | Among the established risk factors for delirium, central sleep apnoea was independently associated with delirium. Our findings contribute to identifying patients at high risk of developing post-operative delirium who may benefit from intensified delirium prevention strategies. | NOS high quality |
| 9 | Xu2021 [94] | China | Cross-sectional study | hypertrophic cardiomyopathy | OSA | N = 589/50.5 ± 12.8yrs | Polysomnography | Data from clinical characteristics and polysomnography studies were recorded. OSA was present in 346 patients (58.7%). Patients who had OSA were older, more likely to be male and had more clinical comorbidities such as hypertension, atrial fibrillation and cardiac remodeling | Combie high quality |
| No OSA | |||||||||
| N = 243/45.7 ± 13.7yrs | |||||||||
| OSA | |||||||||
| N = 346/53.8 ± 11.1yrs | |||||||||
| 10 | Foldvary-Schaefer 2015 [102] |
USA | Prospective cohort study | Cardiovascular Surgery | OSA | N = 107/67.3 ± 13.3yrs | Polysomnography | OSA is highly prevalent in patients undergoing cardiovascular surgery. It could not be shown that OSA was significantly associated with adverse postoperative outcomes, but this may have been due to an insufficient number of subjects. | NOS mid quality |
| AHI˂15 | |||||||||
| N = 56/65.1 ± 13.8yrs | |||||||||
| AHI≥15 | |||||||||
| N = 51/69.7 ± 12.5yrs | |||||||||
| 11 | Ding2016 [101] | China | A Prospective Single-Center Study | Cardiac Valve Replacement Surgery |
OSA | N = 290/51.4 ± 10.4yrs | polysomnography | RVHD patients with OSA have an increased incidence of perioperative adverse events. OSA was independently associated with overall postoperative recovery, respiratory insufficiency, and higher rate of postoperative pacemaker use, while CSA was not associated with postoperative events. | NOS mid quality |
| No SDB | |||||||||
| N = 175/49.13 ± 10.51yrs | |||||||||
| OSA | |||||||||
| N = 54/54.43 ± 9.49yrs | |||||||||
| CSA | |||||||||
| N = 61/55.20 ± 9.05yrs | |||||||||
ACS: acute coronary syndrome; AF: atrial fibrillation; AL: light-chain amyloidosis; AMI: acute myocardial infarction; AV: aortic valvular; ASV: adaptive servo-ventilation.
BQ: Berlin Questionnaire.
CHF: chronic heart failure; CoB: Cochrane Risk of Bias; CRT-D:cardioverter-defibrillator; CSA:central sleep apnea.
DCC: direct current cardioversion; DCM: dilated cardiomyopathy; ESS: Epworth Sleepiness Scale; EDS: excessive daytime sleepiness.
HCM: hypertrophic cardiomyopathy; HFrEF: HF with reduced ejection fraction; HTN: hypertension; HTN: hypertension; IMT: inspiratory muscle training; ISI: Insomnia Severity Scale.
LAVI: left atrial volume index; LVEF: left ventricular ejection fraction.
MDD: major depressive disorder; MISS: Minimal Insomnia Symptom Scale; MHR: monocyte to high-density lipoprotein ratio; MV: mitral valvular.
MINORS: methodological index for non-randomized studies; m-TTR: hereditary transthyretin amyloidosis.
NOS: Newcastle-Ottawa (cohort) scale; NSTEMI: non-ST elevation acute myocardial infarction.
OSA: obstructive sleep apnea.
PAF: paroxysmal AF; PAP: Positive respiratory pressure therapy.
PSQI: Pittsburgh Sleep Quality Index.
RCT: randomized controlled trial; RVHD: rheumatic valvular heart disease.
SAVR: surgical aortic valve replacement; SAS: sleep apnea syndrome; SA: sleep apnea; SR: sinus rhythm; SSD: Short sleep duration.
TAVI: transcatheter aortic valve implantation; TMVR: transcatheter mitral valve repair.
UA: unstable angina; WT-TTR: wild-type transthyretin amyloidosis.