Cardiovascular Outcomes Post Percutaneous Coronary Intervention in Patients with Obstructive Sleep Apnea and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a major risk factor for the occurrence of cardiovascular diseases. Similar to T2DM, obstructive sleep apnea (OSA) is also known to be a risk factor for cardiovascular diseases. In this analysis, we aimed to systematically compare the post-interventional cardiovascular outcomes observed in patients with T2DM with versus without OSA. METHODS: Electronic databases were searched for relevant publications comparing the cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients with T2DM with OSA. Cardiovascular outcomes were considered as the relevant endpoints. The RevMan software 5.3 was used to carry out the statistical analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to represent the results following data assessment. RESULTS: A total of 1168 participants with T2DM were included in this analysis, of whom 614 had co-existing OSA. The time period of patients’ enrollment varied from year 2002 to 2017. Our current analysis showed that major adverse cardiac events (MACEs) (OR 2.28, 95% CI 1.24–4.18; P = 0.008) and all-cause mortality (OR 1.95, 95% CI 1.08–3.54; P = 0.03) were significantly higher in the OSA subgroup. However, major adverse cerebrovascular and cardiovascular (MACCEs) (OR 1.38, 95% CI 0.97–1.98; P = 0.07) and cardiac death (OR 1.79, 95% CI 0.77–4.16; P = 0.18) were not significantly different post PCI. In addition, hospitalization for heart failure (OR 1.99, 95% CI 0.43–9.25; P = 0.38), re-infarction (OR 1.52, 95% CI 0.85–2.70; P = 0.16), stroke (OR 1.81, 95% CI 0.81–4.08; P = 0.15), target vessel revascularization (TVR) (OR 1.54, 95% CI 0.98–2.42; P = 0.06), and target lesion revascularization (TLR) (OR 1.32, 95% CI 0.80–2.18; P = 0.28) were also not significantly different post PCI in the patients with T2DM with versus without OSA. CONCLUSION: OSA was associated with a significant increase in all-cause mortality and MACEs post PCI in these patients with T2DM. Therefore, special care and continuous follow-up might be required for patients with T2DM with associated OSA after PCI. However, as a result of the limited number of participants, further larger studies would be required to confirm these hypotheses.