Sleep and Breathing

, Volume 23, Issue 1, pp 179–191 | Cite as

Obstructive sleep apnea and the effect of CPAP treatment on ischemia-modified albumin levels: a multi effect size meta-analysis with diagnostic test accuracy

  • Seshadri Reddy VarikasuvuEmail author
  • Naveen Dutt
  • Dibakar Sahu
Sleep Breathing Physiology and Disorders • Original Article



A close association of oxidative stress (OS) and ischemia-modified albumin (IMA) with obstructive sleep apnea (OSA) has been reported in the literature, but the results on IMA are ambiguous. We conducted a meta-analysis to evaluate the association of IMA with OSA and the effect of continuous positive airway pressure (CPAP) therapy on IMA in patients with OSA.


Relevant studies were identified by searching PubMed and other databases in addition to manual searching of cross-references. Using random-effects model, the standardized mean differences (SMDs), pooled correlation coefficients and summary of diagnostic test accuracies were obtained with 95% confidence intervals (CIs). The meta-regression, sub-group and sensitivity analyses were performed to explore heterogeneity. The presence of publication bias was tested using funnel plot analysis followed by Begg’s and Egger’s tests for statistical signidicance.


This meta-analysis finally included nine studies. When comparing with non-OSA controls, the OSA patients showed a significantly increased circulatory IMA levels (SMD = 1.15, p = 0.0001). And, this increase is even more pronounced in severe-OSA group as compared to mild-moderate OSA patients (SMD = 076, p = 0.0006). A decrease in post-CPAP treatment IMA was observed when compared with that of baseline values. Meta-analysis of correlations showed significant associations of IMA with polysomnographic parameters. The pooled diagnostic odds ratio and area under curve were 19.58 and 0.888 (Q* = 0.819), respectively. There was no evidence of publication bias for the association of IMA with OSA.


This meta-analysis suggests that OSA is associated with significantly increased IMA levels which may indicate OS, ischemia and subclinical cardiovascular risk. In the diagnostic test accuracy meta-analysis, IMA showed good accuracy for OSA detection. However, further studies are required to establish its clinical utility.


Sleep Obstructive sleep apnea Ischemia-modified albumin Meta-analysis 



Dr. V. S. Reddy is very much thankful to Prof Tiejun Tong, and Luo Dehui (PhD Scholar), Department of Mathematics, Hong Kong Baptist University for their statistical expertise and help in the methodology. All the authors acknowledge the help received from Pragathi Duggina (Sri Padmavati Mahila Visvavidyalayam, Andhra Pradesh), Neelakant Varma (Gujarat Forensic Sciences University, Gujarat), and Raju CH (Dr. raju’s speciality clinics, Telangana) in literature search after it was initially and independently done by two authors (VSR & ND).


No funding was received for this research.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

For this type of study, ethical approval is not required.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

11325_2018_1679_MOESM1_ESM.pdf (586 kb)
ESM 1 (PDF 586 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Medicine, Department of BiochemistryMaheshwara Medical College & HospitalHyderabadIndia
  2. 2.Department of Pulmonary MedicineAll India Institute of Medical SciencesJodhpurIndia
  3. 3.Department of Pulmonary MedicineAll India Institute of Medical SciencesRaipurIndia

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