Efficacy of continuous positive airway pressure on cardiac remodeling and ventricular function in obstructive sleep apnea: a systematic review and updated meta-analysis of speckle-tracking echocardiography

Obstructive sleep apnea (OSA) is associated with structural heart disease, with continuous positive airway pressure (CPAP) potentially improving cardiac remodeling. This meta-analysis provides an updated assessment of CPAP's effects on myocardial strain and remodeling in patients with OSA. A systematic review and meta-analysis of clinical studies evaluating CPAP's effects on speckle-tracking echocardiographic parameters in OSA patients was conducted. PubMed, Embase and Cochrane Central were searched. A random-effects model analyzed pooled data. Studies assessing right ventricular global longitudinal strain (RV-GLS) or left ventricular global longitudinal strain (LV-GLS) were included. Ten studies [one randomized controlled trial (RCT), nine observational] involving 385 patients treated with CPAP were analyzed. CPAP significantly improved left ventricular GLS -1.92% [-2.63 to -1.21] (MD [95% confidence interval]), P < 0.01; and right ventricular GLS -1.88% [-2.77 to -0.99], P < 0.01. No significant changes were observed in LVEF 0.77% [-0.65 to 2.18] P = 0.29; TAPSE 0.07 mm [-0.53 to 0.68] P = 0.81, I2 = 0%; LV mass [SMD -0.22; -0.56 to 0.12] P = 0.54, I2 = 0%; PVR -0.59 [-1.25 to 0.04] P = 0.08; or E/e' ratio -0.95 [-2.42 to 0.53], P = 0.21. CPAP significantly reduced PASP -5.23 mmHg [-8.54 to -1.92], P = 0.002, I2 = 64%; and right atrial volume index -3.96 ml/m 2 [-5.43 to -2.50], P < 0.001, with no significant change in left atrial volume [SMD -0.01; -0.35 to 0.32], P = 0.93. CPAP therapy improves both left and right ventricular function and reduces right atrial volume in patients with OSA. Further trials are needed to assess CPAP's long-term impact on myocardial strain and cardiac mechanics beyond conventional echocardiography.