Genta Bunjaku

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder associated with increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the standard treatment for OSA; however, its effects on cardiovascular outcomes remain incompletely established. This umbrella review synthesized and critically appraised the evidence regarding the effects of CPAP on surrogate, intermediate, and functional cardiovascular outcomes in adults with OSA. Materials and Methods: An umbrella review of systematic reviews and meta-analyses evaluating CPAP therapy in adults with OSA was conducted. A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library from database inception to 28 February 2026. Eligible reviews assessed cardiovascular outcomes, including blood pressure, cardiac function, autonomic function, cardiovascular biomarkers, and functional cardiovascular measures. Methodological quality was evaluated using AMSTAR 2, and the certainty of evidence for the main outcomes was assessed using the GRADE framework. Results: Thirty-eight systematic reviews and meta-analyses were included. CPAP therapy was consistently associated with reductions in systolic blood pressure (mean difference [MD] −4.8 mmHg) and diastolic blood pressure (MD −3.0 mmHg), with additional improvements in 24 h ambulatory blood pressure. Favorable effects were also observed for left ventricular ejection fraction (MD 3.27), left ventricular diastolic function (weighted mean difference [WMD] 0.22), and sympathetic nervous system activity, reflected by lower circulating noradrenaline levels (standardized mean difference [SMD] −1.10) in randomized controlled trials. Improvements in BNP/NT-proBNP concentrations and New York Heart Association functional class were reported among patients with heart failure, whereas no significant effect was observed on body mass index. The certainty of evidence ranged from low to moderate, and methodological confidence of the included reviews was predominantly moderate, low, or critically low. Conclusions: CPAP therapy was associated with improvements in several surrogate, intermediate, and functional cardiovascular outcomes in adults with OSA, particularly blood pressure, left ventricular function, and sympathetic activity. However, the certainty of evidence ranged from low to moderate, and substantial heterogeneity and methodological limitations warrant cautious interpretation. Current evidence remains insufficient to demonstrate a consistent reduction in major adverse cardiovascular events or cardiovascular mortality. Further high-quality randomized controlled trials with longer follow-up are needed to clarify the long-term cardiovascular impact of CPAP therapy.

Background: Unnecessary caesarean births may be affected by physician factors, such as preferences, incentives and convenience. Delivery during office hours can be a valuable proxy for measuring such effects. Objective: To determine the effect of office hours on the decision for caesarean delivery by assessing the odds of caesarean during office hours compared to out-of-office hours. Search strategy: We searched CINAHL, ClinicalTrials.gov, The Cochrane Library, PubMed, Scopus and Web of Science from the beginning of records through August 2021. Data collection and analysis: Search results were screened by three researchers. First, we selected studies that reported odds ratios of caesareans, or data allowing their calculation, for office and out-of-office hours. We extracted data on the study population, study design, data sources, setting, type of caesarean section, statistical analysis, and outcome measures. For groups reporting the same outcome, we performed a standard inverse-variance random-effects meta-analysis, which enabled us to calculate the overall odds ratios for each group. For groups reporting varying outcomes, we performed descriptive analysis. Main results: Meta-analysis of weekday vs weekend for any caesarean section showed higher odds of caesarean during weekdays in adjusted analysis 1.40 (95%CI 1.13, 1.72 from 1,952,691 births). A similar effect was observed in the weekday vs Sunday comparison (1.39, 95%CI 1.10, 1.75, 150,932 births). A lower effect was observed for emergency CS, with a slight increase in adjusted analysis (1.06, 95%CI 0.90, 1.26, 2,622,772 births) and a slightly higher increase in unadjusted analysis (1.15, 95%CI 1.03, 1.29, 12,591,485 births). Similar trends were observed in subgroup analyses and descriptive synthesis of studies examining other office hours outcomes. Conclusions: Delivery during office hours is associated with higher odds for overall caesarean sections and little to no effect for emergency caesarean. Non-clinical factors associated with office hours may influence the decision to deliver by caesarean section. Further detailed investigation of the “office hours effect” in delivery care is necessary and could lead to improvements in care systems. Funding: The authors received no direct funding for this study.

OBJECTIVE: To assess the association of the gender of the delivering physician and the odds of performing cesarean delivery. DATA SOURCES: CINAHL, ClinicalTrials.gov, Cochrane Library, PubMed, Scopus and Web of Science from the first year of records through May 2020. METHODS OF STUDY SELECTION: We included studies that reported odds ratios (OR), or data allowing the calculation of ORs, for cesarean delivery performed by female and male delivering physicians. We also included studies that reported the preference of physicians for performing cesarean deliveries. TABULATION, INTEGRATION, AND RESULTS: Independent data extraction was carried out by at least two researchers. Standard inverse-variance random effects meta-analysis was used to generate overall ORs. Finally, in two separate meta-analyses, we analyzed 15 studies containing clinical data for 1,269,625 births, and 11 studies containing data for the preference for delivery mode of 4,911 obstetricians. Both the crude and adjusted odds of a cesarean delivery were lower for those performed by female physicians (crude OR 0.75, 95% CI 0.68–0.84, τ ² =0.029, adjusted OR 0.74, 95% CI 0.65–0.85, τ ² =0.031). We also found that female physicians had a lower preference for cesarean delivery in both crude and adjusted analysis (crude OR 0.59, 95% CI 0.36–0.96, I ² =77%, adjusted OR 0.58, 95% CI 0.40–0.84, I ² =67%). CONCLUSION: Female physicians are less likely to perform cesarean delivery and less likely to prefer it. This was observed across different health systems and populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020158442.