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Effects of sleep apnea hypopnea syndromes on cardiovascular events: a systematic review and meta-analysis

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Abstract

Purpose

Previous studies suggest that sleep apnea hypopnea syndrome (SAHS) is an independent risk factor that contributes to certain cardiovascular events. However, there are studies arguing that patients with SAHS had lower peak troponin levels when suffering cardiovascular events compared to patients without SAHS, which indicates that there may potentially be a protective effect of SAHS. This meta-analysis aimed to assess the impact of SAHS on cardiovascular events.

Methods

Databases were searched for studies that examined cardiac biomarkers or reported angiographic data when patients with SAHS experienced cardiovascular events. The data about peak cardiac biomarkers and angiographic coronary lesion were extracted and then used to compute the pooled standardized mean difference (SMD) and 95% confidence interval (95% CI).

Results

Among 26 studies included in the meta-analysis, there was not a definite difference between the SAHS group and the control group for troponins (SMD, 0.05; 95% CI, [− 0.16, 0.26]), creatine kinase (SMD, − 0.08; 95% CI, [− 0.38, 0.22]), and CK-MB (SMD, − 0.11; 95% CI, [− 0.51, 0.29]). However, patients with SAHS revealed worse coronary lesion condition grading via both Gensini score (SMD, 0.63; 95% CI, [0.31, 0.95]) and SYNTAX score (SMD, 0.99; 95% CI, [0.31–1.67]).

Conclusions

Ischemic preconditioning induced by the intermittent hypoxia at the early stage could generate a cardiac protection effect, which would then benefit SAHS patients encountering a major adverse cardiovascular event.

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Authors and Affiliations

  1. School of Medicine, Southeast University, Nanjing, China

    Liang Xie, Penghao Zhen, Fuchao Yu & Jiayi Tong

  2. Jinling Hospitial, School of Medicine, Nanjing University, Nanjing, China

    Liang Xie

  3. Department of Cardiology, Zhongda Hospital, Nanjing, China

    Penghao Zhen, Fuchao Yu & Jiayi Tong

  4. School of Public Health, Southeast University, 87 Dingjiaqiao, Nanjing, China

    Xiaojin Yu

  5. Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China

    Hai Qian

  6. State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biomedical Sciences and Medical Engineering, Southeast University, Nanjing, China

    Fang Yang

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Supplementary Information

Supplementary Fig. 1

Detailed Search Strategy (PDF 78 kb).

Supplementary Fig. 2

Galbraith Plot of studies reporting peak troponins. (PDF 281 kb).

Supplementary Fig. 3

Subgroup analysis by publication countries of studies reporting peak CK. (PDF 3 kb).

Supplementary Fig. 4

Sensitivity analysis of studies reporting peak CK-MB. (PDF 76 kb).

Supplementary Fig. 5

Subgroup analysis by publication countries of studies reporting peak CK-MB. (PDF 3 kb).

Supplementary Fig. 6

Sensitivity analysis of studies reporting Gennsini scores. (PDF 135 kb).

Supplementary Fig. 7

Sensitivity analysis of studies reporting SYNTAX scores. (PDF 64 kb).

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Xie, L., Zhen, P., Yu, F. et al. Effects of sleep apnea hypopnea syndromes on cardiovascular events: a systematic review and meta-analysis. Sleep Breath 26, 5–15 (2022). https://doi.org/10.1007/s11325-021-02294-3

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