Search

International audience

A previous aggregate data (AD) meta-analysis showed that obstructive sleep apnoea patients had lower exercise capacity compared to controls (Mendelson et al. ERJ 2018). However, these authors reported a high level of heterogeneity, which may be explained by methodological limitations including an OSA definition apnoea-hypopnoea index (AHI) which varied from 5 to 30. The aim of this meta-analysis was to confirm whether exercise capacity is altered in moderate to severe OSA patients using individual patient data (IPD) and AD meta-analysis. A two-stage IPD meta-analysis model was used, allowing to standardize the apnea cutoff (AHI ≥15) and adjust for confounders. Nonrandomized trials performing sleep recording and exercise test with a measured of maximal oxygen consumption (VO2peak) were searched using PubMed, Embase and Web of Science. From the 666 studies identified, 18 met inclusion criteria. IPD were sought for this 18 studies and obtained from 5 trials (28% of all studies, N=289). For the 13 other studies, AD were used in sensitivity analyses (N=605). IPD meta-analysis demonstrated that OSA patients had similar VO2peak (mean difference (MD): -1.0 mL.kg-1.min-1; 95% CI: -3.8 to 1.8; p=0.47) with low heterogeneity compared to mild or non-OSA patients while AD meta-analysis revealed that VO2peak was reduced in OSA patients (MD: -2.3 mL.kg-1.min-1; 95% CI: -4.0 to -0.6; p In conclusion, IPD meta-analysis suggests that exercise capacity is preserved in moderate to severe OSA patients while AD meta-analysis suggests lower VO2peak in severe OSA.

Background: Because of clinical similarities, pulmonary embolism (PE) suspicion may be difficult in COPD outpatients admitted for acute exacerbation (COPD-E), and PE may occur in inpatients hospitalized for COPD-E. Observational studies founded a wide range of PE prevalence during COPD-E. As PE prevalence may vary according to patients’ setting, we assessed PE prevalence in patients with COPD-E according to their status (outpatients vs inpatients). Methods: We performed a meta-analysis of observational prospective studies investigating PE prevalence in patients admitted for COPD-E. Included studies were only those with systematic PE assessment in patients admitted for COPD-E as the primary aim. The primary endpoint was prevalence of objectively confirmed PE, weighted by the size of the study, and thereafter according to patients’ setting. A sensitivity analysis was performed in the following subcategories: definition of COPD using spirometry, definition of COPD-E. Results: Fourteen studies (2016 patients) were included. The overall PE prevalence was 17% (95%CI [11-23], random effects model). PE prevalence (figure 1) was lower for outpatients (9% [2-19]) than inpatients (20% [11-31]), p for interaction=0.12. The prevalence was not influenced by definition of COPD using spirometry or definition of COPD-E. Conclusion: Our meta-analysis highlights that the PE prevalence varies according to patients’ setting doubling from emergency department to medical ward.