The Effect of Sleep Disorder Interventions in Patients With Obstructive Sleep Apnea Undergoing Solid-Organ Transplants: A Systematic Review.

Abstract

Poor sleep results in a wide range of health consequences, and is prevalent among patients undergoing solid-organ transplant, who have high rates of obstructive sleep apnea (OSA). Our objective was to synthesize the evidence examining the impact of OSA therapies such as continuous positive airway pressure (CPAP) on outcomes in the solid-organ transplant setting. We conducted a systematic review registered via PROSERO (CRD42024512577) and reported in accordance with PRISMA guidelines. Databases searched included: MEDLINE, MEDLINE ePubs Ahead of Print and In-process Citations, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. Included studies were those investigating interventions used in adult patients (≥18 years) with OSA undergoing solid-organ transplantation. A total of 1407 studies were identified, with screening identifying 38 studies for full-text review, and only 3 were eligible for data extraction. Only 1 study in heart transplant patients evaluated changes in sleep parameters, and demonstrated that the implementation of nasal CPAP led to significant improvements in Apnea-Hypopnea Index, Arousal Index, and total sleep time with oxygen saturation <90%. Patients with untreated OSA were more likely to develop graft dysfunction earlier than patients with treated or no OSA. There was no detectable impact of CPAP on 1-year mortality or 5-year overall survival after adjustment. Future studies, namely RCTs, should be conducted to assess the tolerability, compliance, and effectiveness of CPAP in this at-risk population. Additional studies should focus on optimizing sleep in solid-organ transplant populations by providing interventions and education that best match individual patient needs, with engagement from patient partners.