Association Between Obstructive Sleep Apnea and Post-Myocardial Infarction All-Cause Mortality: A Systematic Review and Meta-Analysis

Objectives: Evidence regarding the association between obstructive sleep apnea (OSA) and mortality following acute myocardial infarction (MI) remains inconsistent. This study aimed to clarify this relationship through a systematic review and meta-analysis.Methods: A comprehensive search of six international databases (PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and Embase) was conducted on November 11, 2024, without time restrictions. Statistical analyses included a random-effects model stratified by adjusted odds ratio (aOR) and adjusted hazard ratio (aHR). Short-term mortality was defined as in-hospital or ≤30-day mortality, whereas long-term mortality referred to outcomes assessed after a minimum follow-up of 3 months. Data synthesis was performed using Comprehensive Meta-Analysis software (Version 2).Results: Six studies, including a total of 7,032,232 individuals, showed that short-term post–acute MI mortality was lower among individuals with OSA (aOR=0.67; 95% confidence interval [CI] 0.61–0.74). In contrast, pooled analysis of seven additional studies (n=12,545) reporting aHR indicated that OSA was associated with a 53% increased risk of long-term mortality (aHR=1.53; 95% CI 1.22–1.92). Egger’s test showed no evidence of publication bias.Conclusions: OSA did not show a significant association with increased short-term post-MI mortality in aOR-based analyses but was linked to a higher risk of long-term mortality in aHR-based analyses. This discrepancy may reflect methodological differences, including the absence of time-to-event modeling in aOR and the greater sensitivity of aHR, as well as variations in study design and follow-up duration. Further well-designed studies are required to confirm these findings.