-
Antioxidants (Basel, Switzerland) Jun 2021Oxidative stress induced by nocturnal intermittent hypoxia plays a significant pathophysiological role in obstructive sleep apnea (OSA). Malondialdehyde (MDA), one of... (Review)
Review
Oxidative stress induced by nocturnal intermittent hypoxia plays a significant pathophysiological role in obstructive sleep apnea (OSA). Malondialdehyde (MDA), one of the most commonly investigated markers of lipid peroxidation, might assist with the monitoring of oxidative balance in OSA. We conducted a systematic review and meta-analysis to evaluate the differences in circulating MDA concentrations between patients with OSA and non-OSA controls. A systematic search was conducted in the electronic databases Pubmed, Web of Science, Scopus and Google Scholar from inception to December 2020 by using the following terms: "malondialdehyde" or "MDA"; and "Obstructive Sleep Apnea Syndrome", "OSAS" or "OSA". We identified 26 studies in 1223 OSA patients and 716 controls. The pooled MDA concentrations were significantly higher in patients with OSA (standardized mean difference (SMD) 1.43 μmol/L, 95% confidence interval (CI) 1.03 to 1.83 μmol/L, < 0.001). There was extreme heterogeneity between the studies (I = 92.3%, < 0.001). In meta-regression analysis, the SMD was significantly associated with age, the assay type used and publication year. In our meta-analysis, MDA concentrations were significantly higher in OSA patients than in controls. This finding suggests that MDA, which is a marker of lipid peroxidation, is involved in the pathogenesis of OSA and provides insights for future studies investigating its potential clinical use.
PubMed: 34210032
DOI: 10.3390/antiox10071053 -
Journal of Clinical Sleep Medicine :... Jul 2022This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA). (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA).
METHODS
Seven databases were searched to fulfill our research objectives. Clinical studies that included participants younger than 18 years with fully diagnosed OSA or without OSA and that evaluated skeletal, soft craniofacial features, or dental arch morphology were considered for this review. The risk of bias and certainty of evidence were assessed. A meta-analysis was performed when low methodological and clinical heterogeneity were detected. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA-2020) guidelines.
RESULTS
Nine studies were identified at the end of the selection process, from which 5 did not report differences. Four studies reported differences between craniofacial features when OSA was compared to an asymptomatic control group. Mandibular retrognathia, reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids), longer facial profile, and a narrower intercanine width were described among children with OSA. A meta-analysis was performed considering the studies with a similar methodological approach, and no differences were observed in all the considered cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN). All the included studies were considered at low risk of bias even though some limitations were noted.
CONCLUSIONS
Due to the very low to moderate level of certainty, neither an association nor a lack thereof between craniofacial morphology and pediatric OSA can be supported by these data.
CITATION
Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. . 2022;18(7):1865-1875.
Topics: Adenoids; Adolescent; Cephalometry; Child; Humans; Pharynx; Sleep Apnea, Obstructive
PubMed: 35074045
DOI: 10.5664/jcsm.9904 -
Annals of Palliative Medicine Dec 2021Obstructive sleep apnea hypopnea syndrome (OSAHS) is defined as more than 30 recurrent episodes of apnea or a sleep apnea hypopnea index (AHI) of more than 5 times/hour... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnea hypopnea syndrome (OSAHS) is defined as more than 30 recurrent episodes of apnea or a sleep apnea hypopnea index (AHI) of more than 5 times/hour at a night. It is more common in people over 40 years old and is more prevalent in men. The pathogenesis factors and correlations of OSAHS are worth studying.
METHODS
A literature search was performed in the PubMed, Embase, and Ovid-Medline databases from the date when the database was established to April 2021. Keywords included obstructive sleep apnea hypopnea syndrome, sleep apnea hypopnea syndrome, hypertension, and correlation.
RESULTS
Eight articles involving 3,484 OSAHS patients were included. Analysis results showed that OSAHS was correlated with hypertension [odds ratio (OR) =6.44, 95% confidence interval (CI): 5.38-7.71, P<0.00001]. The severity of OSAHS revealed that the correlation of hypertension to mild, moderate, and severe OSAHS showed OR =1.93, 95% CI: 0.69-5.43, P=0.21, OR =0.43, 95% CI: 0.24-0.74, P=0.0003, and OR =0.85, 95% CI: 0.42-1.73, P=0.66, respectively. The results indicated that mild, moderate, and severe OSAHS are risk factors for hypertension.
DISCUSSION
Eight articles were included to determine the correlation between OSAHS and hypertension. It was found that OSAHS was closely correlated with hypertension, and they may be risk factors for each other.
Topics: Adult; Humans; Hypertension; Male; Risk Factors; Sleep Apnea, Obstructive; Syndrome
PubMed: 35016417
DOI: 10.21037/apm-21-3302 -
Medicina (Kaunas, Lithuania) Oct 2022Background and objective: Intercellular adhesion molecule-1 (ICAM-1) appears to be an active and important biomarker for decreasing the risk of cardiovascular issues... (Meta-Analysis)
Meta-Analysis Review
Background and objective: Intercellular adhesion molecule-1 (ICAM-1) appears to be an active and important biomarker for decreasing the risk of cardiovascular issues among individuals with obstructive sleep apnea (OSA). Herein, a systematic review and meta-analysis was designed to probe whether plasma/serum ICAM-1levels are different in adults with OSA compared to adults with no OSA, as well as adults with severe OSA compared to adults with mild/moderate OSA. Materials and methods: A thorough and systematic literature search was performed in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) until 17 July 2022, without any age and sample size restrictions to retrieve the relevant articles. The standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of ICAM-1 levels was reported. Analyses, including sensitivity analysis, subgroup analysis, trial sequential analysis, meta-regression, and a funnel plot analysis, were performed in the pooled analysis. Results: A total of 414 records were identified in the databases, and 17 articles including 22 studies were entered into the meta-analysis. The pooled SMD of serum/plasma ICAM-1 levels in adults with OSA compared to controls was 2.00 (95%CI: 1.41, 2.59; p < 0.00001). The pooled SMD of serum/plasma ICAM-1 levels in adults with severe compared to mild/moderate OSA was 3.62 (95%CI: 1.74, 5.51; p = 0.0002). Higher serum/plasma ICAM-1 levels were associated with a higher mean age of controls, higher scores for the apnea-hypopnea index, and with a lower mean age of adults with OSA and with smaller sample sizes. Conclusions: Th results of the present meta-analysis showed that serum/plasma ICAM-1 levels in adults with OSA was higher than serum/plasma ICAM-1 levels in controls. Similarly, serum/plasma ICAM-1 levels in adults with severe OSA were higher compared to serum/plasma ICAM-1 levels of adults with mild or moderate OSA. Therefore, ICAM-1 may be used as an additional diagnostic and therapeutic biomarker in adults with OSA.
Topics: Adult; Humans; Intercellular Adhesion Molecule-1; Sleep Apnea, Obstructive; Biomarkers
PubMed: 36295659
DOI: 10.3390/medicina58101499 -
Journal of Clinical Sleep Medicine :... Jun 2021The recognition of specific endotypes as drivers of sleep apnea suggests the need of therapies targeting individual mechanisms. Acetazolamide is known to stabilize... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
The recognition of specific endotypes as drivers of sleep apnea suggests the need of therapies targeting individual mechanisms. Acetazolamide is known to stabilize respiration at high altitude but benefits at sea level are less well understood.
METHODS
All controlled studies of acetazolamide in obstructive sleep apnea and/or central sleep apnea (CSA) were evaluated. The primary outcome was the apnea-hypopnea index.
RESULTS
Fifteen trials with a total of 256 patients were pooled in our systematic review. Acetazolamide reduced the overall apnea-hypopnea index (mean difference [MD] -15.82, 95% CI: -21.91 to -9.74, P < .00001) in central sleep apnea (MD -22.60, 95% CI: -29.11 to -16.09, P < .00001), but not in obstructive sleep apnea (MD -10.29, 95% CI: -33.34 to 12.77, P = .38). Acetazolamide reduced the respiratory related arousal index (MD -0.82, 95% CI: -1.56 to -0.08, P = .03), improved partial arterial of oxygen (MD 11.62, 95% CI: 9.13-14.11, P < .00001), mean oxygen saturation (MD 1.78, 95% CI: 0.53-3.04, P = .005), total sleep time (MD 25.74, 95% CI: 4.10-47.38, P = .02), N2 sleep (MD 3.34, 95% CI: 0.12-6.56, P = .04) and sleep efficiency (MD 4.83, 95% CI: 0.53-9.13, P = .03).
CONCLUSIONS
Acetazolamide improves the apnea-hypopnea index and several sleep metrics in central sleep apnea. The drug may be of clinical benefit in patients with high loop gain apnea of various etiologies and patterns. The existence of high heterogeneity is an important limitation in applicability of our analysis.
SYSTEMATIC REVIEW REGISTRATION
Registry: PROSPERO; Name: The effect of acetazolamide in patients with sleep apnea at sea level: a systematic review and meta analysis; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020163316; Identifier: CRD42020163316.
Topics: Acetazolamide; Carbonic Anhydrase Inhibitors; Humans; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33538687
DOI: 10.5664/jcsm.9116 -
International Archives of Occupational... Nov 2021Shift work is a workschedule, since industrial era and some employees work in shift. It causes a desynchronization of the biological clock with consequences on sleep... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Shift work is a workschedule, since industrial era and some employees work in shift. It causes a desynchronization of the biological clock with consequences on sleep amount and quality, such as insomnia and easy fatigue. Obstructive sleep apnea (OSA) is one of the sleep problems that are getting more and more attention, but studies on the association between shift work and OSA were rare. Herein, we aimed to conduct a systematic review and meta-analysis to investigate the association between shift work and possible OSA.
METHODS
This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed, Embase, and Web of Science databases using a related set of keywords. The inclusion criteria were as follows: (1) participants were adult employees hired by a company or organization; (2) exposure was shift work; and (3) outcome was possible OSA according to examination or assessment.
RESULTS
We included six studies in the systematic review and five studies were selected for further meta-analysis. A random-effects model showed an association of shift work with a small, non-significant increase in possible OSA cases (pooled prevalence relative risk = 1.05; 95% CI 0.85-1.30; p = 0.65). This association occurred in both healthcare and non-healthcare workers group.
CONCLUSION
The association between shift work and possible OSA remains inconclusive and could be small if not negligible. Future studies should assess the association between specific work schedules and specific OSA definitions.
TRIAL REGISTRATION NUMBER
PROSPERO ID: CRD42020156837.
Topics: Humans; Shift Work Schedule; Sleep Apnea, Obstructive
PubMed: 33677677
DOI: 10.1007/s00420-021-01675-1 -
Journal of Sleep Research Feb 2023Obstructive sleep apnea is a chronic, sleep-related breathing disorder, which is an independent risk factor for cardiovascular disease. The renin-angiotensin-aldosterone... (Meta-Analysis)
Meta-Analysis Review
Obstructive sleep apnea is a chronic, sleep-related breathing disorder, which is an independent risk factor for cardiovascular disease. The renin-angiotensin-aldosterone system regulates salt and water homeostasis, blood pressure, and cardiovascular remodelling. Elevated aldosterone levels are associated with excess morbidity and mortality. We aimed to analyse the influence and implications of renin-angiotensin-aldosterone system derangement in individuals with and without obstructive sleep apnea. We pooled data from 20 relevant studies involving 2828 participants (1554 with obstructive sleep apnea, 1274 without obstructive sleep apnea). The study outcomes were the levels of renin-angiotensin-aldosterone system hormones, blood pressure and heart rate. Patients with obstructive sleep apnea had higher levels of plasma renin activity (pooled wmd+ 0.25 [95% confidence interval 0.04-0.46], p = 0.0219), plasma aldosterone (pooled wmd+ 30.79 [95% confidence interval 1.05-60.53], p = 0.0424), angiotensin II (pooled wmd+ 5.19 [95% confidence interval 3.11-7.27], p < 0.001), systolic (pooled wmd+ 5.87 [95% confidence interval 1.42-10.32], p = 0.0098) and diastolic (pooled wmd+ 3.40 [95% confidence interval 0.86-5.94], p = 0.0086) blood pressure, and heart rate (pooled wmd+ 3.83 [95% confidence interval 1.57-6.01], p = 0.0009) compared with those without obstructive sleep apnea. The elevation remained significant (except for renin levels) when studies involving patients with resistant hypertension were removed. Sub-group analysis demonstrated that levels of angiotensin II were significantly higher only among the Asian population with obstructive sleep apnea compared with those without obstructive sleep apnea. Body mass index accounted for less than 10% of the between-study variance in elevation of the renin-angiotensin-aldosterone system parameters. Patients with obstructive sleep apnea have higher levels of renin-angiotensin-aldosterone system hormones, blood pressure and heart rate compared with those without obstructive sleep apnea, which remains significant even among patients without resistant hypertension.
Topics: Humans; Renin-Angiotensin System; Aldosterone; Renin; Angiotensin II; Sleep Apnea, Obstructive; Hypertension; Blood Pressure; Hormones
PubMed: 36104933
DOI: 10.1111/jsr.13726 -
PloS One 2015Obstructive sleep apnea syndrome (OSAS) is a common disease that increases the risk of diabetes, heart disease, and stroke. However, studies of an association between... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstructive sleep apnea syndrome (OSAS) is a common disease that increases the risk of diabetes, heart disease, and stroke. However, studies of an association between OSAS and glaucoma neuropathy have reported controversial findings.
OBJECTIVE
The main purpose of this study was to evaluate whether a significant association exists between OSAS and glaucoma by performing a meta-analysis of previous studies.
METHODS
A comprehensive literature search using the PubMed and Embase databases was performed to identify cross-sectional, case-control, and cohort studies related to the topic. We estimated a pooled odds ratio (OR) for the association between OSAS and glaucoma, by a fixed- or random-effects model.
RESULTS
In total, 16 studies with 2,278,832 participants met the inclusion criteria: one retrospective cohort study reported an adjusted hazard ratio of glaucoma of 1.67 (95% CI = 1.30-2.17). Using a fixed-effects model, the pooled OR of six case-control studies was 1.96 (95% CI = 1.37 2.80). A significant association was also identified in a meta-analysis of nine cross-sectional studies using a random-effects model, which showed a pooled OR of 1.41 (95% CI = 1.11 1.79). However, the reported pooled estimates for case control studies and cross-sectional studies were based on unadjusted ORs.
CONCLUSIONS
Our results suggest that OSAS is associated with the prevalence of glaucoma. However, this result was based only on unadjusted estimates. Prospective cohort studies designed to take into consideration potential confounders, or examination of data from interventional trials to determine whether a reduction in OSAS status is associated with a reduced incidence of glaucoma, are needed to clarify whether OSAS is an independent risk factor for glaucoma.
Topics: Comorbidity; Glaucoma; Humans; Incidence; Prevalence; Risk; Sleep Apnea, Obstructive
PubMed: 25705901
DOI: 10.1371/journal.pone.0115625 -
Journal of Clinical Sleep Medicine :... Jun 2017In approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position. This is referred to as... (Meta-Analysis)
Meta-Analysis Review
Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis.
STUDY OBJECTIVES
In approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position. This is referred to as position-dependent OSA or POSA. Patients with POSA can be treated with a small device attached to either the neck or chest. These devices-a new generation of devices for positional therapy (PT)-provide a subtle vibrating stimulus that prevents patients adopting the supine position. The objectives of this study were to determine whether PT is effective in improving sleep study variables and sleepiness, and to assess compliance.
METHODS
A systematic review and meta-analysis.
RESULTS
Three prospective cohort studies and four randomized controlled trials were included in this review. Combined data for studies reporting on the effect of PT show that there was a mean difference of 11.3 events/h (54% reduction) in apnea-hypopnea index and 33.6% (84% reduction) in percentage total sleeping time in the supine position. The standardized mean difference for both parameters demonstrated a large magnitude of effect (> 0.8 in both cases).
CONCLUSIONS
There is strong evidence that the new generation of devices for PT are effective in reducing the apnea-hypopnea index during short-term follow-up. These devices are simple-to-use for patients and clinicians and are reversible. Under study conditions with short-term follow-up, compliance is high; however, long-term compliance cannot be assessed because of lack of reliable data. Additional long-term, high-quality studies are needed to confirm the role of PT as a single or as a combination treatment modality for OSA patients and to assess long-term compliance.
Topics: Clinical Alarms; Equipment Design; Posture; Sleep Apnea, Obstructive; Treatment Outcome; Vibration
PubMed: 28212691
DOI: 10.5664/jcsm.6622 -
Tanaffos Jan 2021Obstructive sleep apnea (OSA) is a chronic breathing disorder during sleep. It is prevalent among patients with cardiovascular disease (CVD) and can increase its... (Review)
Review
A Systematic Review and Meta-Analysis of Prevalence of Obstructive Sleep Apnea in Iranian Patients with Cardiovascular Disease: Perspective of Prevention, Care and Treatment.
BACKGROUND
Obstructive sleep apnea (OSA) is a chronic breathing disorder during sleep. It is prevalent among patients with cardiovascular disease (CVD) and can increase its severity and mortality. Various studies have reported different results in Iran. This systematic review and meta-analysis aimed to determine the prevalence of OSA in Iranian patients with CVD.
MATERIALS AND METHODS
In this study, eight papers published in Persian and English languages were reviewed. The articles were searched using the following keywords and all their possible combinations: "obstructive sleep apnea", "sleep-disordered breathing", "sleep apnea", "OSA", "cardiovascular disease", "hypertension", and "Iran". Scientific databases, including the Scientific Information Database (SID), Magiran, Web of Science, PubMed, and Scopus, were searched with no time limitations. Data were analyzed using a meta-analysis and a random effects model. Besides, heterogeneity was assessed using the I statistic. Data analysis was performed in Stata version 11.
RESULTS
The review of eight studies, with a total sample size of 1646 patients, showed that the prevalence of OSA was 59.21% (95% CI: 53.11-65.32) among CVD patients. Also, the prevalence of OSA was higher in men (60.12%; 95% CI: 60.12-82.54) than in women (41.01%; 95% CI: 16.08-65.94). Besides, it was estimated to be higher based on the STOP and STOP-BANG questionnaires (63%; 95% CI: 52.89-73.10) as compared to the Berlin questionnaire (56.63%; 95% CI: 49.20-64.06).
CONCLUSION
More than half of Iranian CVD patients have OSA. Therefore, identifying high-risk patients to reduce the adverse effects of sleep apnea seems necessary.
PubMed: 34394364
DOI: No ID Found