Abstract
Background
Obstructive sleep apnea (OSA) has gastrointestinal implications as it is associated with gastroesophageal reflux disease. Less certain is an independent association between OSA and Barrett’s esophagus. We performed a systematic review and meta-analysis to evaluate the association between OSA and Barrett’s esophagus.
Methods
A systematic search of Ovid MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials was performed. Inclusion criteria were observational studies (retrospective and case–control) assessing the association between OSA and Barrett’s esophagus in adult subjects. Data from the included studies were extracted and used to calculate the pooled odds ratio of OSA with 95% confidence interval (CI) between patients with Barrett’s esophagus and those without, using a random-effects model.
Results
Altogether six studies involving 2333 subjects met the inclusion criteria and were included in this meta-analysis. The pooled analysis found a significantly increased risk of OSA, high risk of OSA, and patient-reported OSA symptoms among patients with Barrett’s esophagus versus those without Barrett’s esophagus, with a pooled odds ratio (OR) of 2.19 (95% CI 1.53–3.15). A subgroup analysis for cases of definite OSA (formally diagnosed via polysomnography) and Barrett’s esophagus (n = 2 studies) also demonstrated significant association (OR 2.59, 95% CI 1.39–4.84).
Conclusion
A significantly increased risk of OSA among patients with Barrett’s esophagus was demonstrated in this meta-analysis. Further investigation is warranted to determine the pathophysiology and clinical implications of this association.
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Appendix
Appendix
Name of search | Obstructive sleep apnea and Barrett’s esophagus |
Databases search | MEDLINE, Embase, CINAHL, Web of Science, Central Register of Controlled Trials (CENTRAL) |
Inclusion criteria | Observational studies assessing association between obstructive sleep apnea and Barrett’s esophagus in adults |
Exclusion criteria | |
Concept 1 | Obstructive sleep apnea |
Concept 2 | Barrett’s esophagus |
Database | Ovid MEDLINE and epub ahead of print, in-process and other non-indexed citations and daily | |
Years searched | 1946 to May 15, 2020 | |
Date last searched | May 18, 2020 | |
Limits | Humans (search hedge) | |
Number of results | 16 | |
Notes | ||
1 | exp sleep apnea syndromes/ | 35,201 |
2 | (sleep$ adj3 apn?ea$).tw. | 36,532 |
3 | hypopn?ea$.tw. | 11,731 |
4 | (hypoventilat$ adj3 (obes$ or obstruct$)).tw. | 781 |
5 | pickwick$.tw. | 387 |
6 | osa.tw. | 13,714 |
7 | osahs.tw. | 1427 |
8 | or/1-7 | 47,826 |
9 | barrett esophagus/ | 7796 |
10 | (barret$ adj3 (dysplas$ or epitheli$ or esophagus$ or metaplas$ or mucosa$ or oesophagus$ or syndrom$)).tw. | 9146 |
11 | (column$ adj3 (line$ or metaplas$)).tw. | 2613 |
12 | (intestin$ adj3 (dysplas$ or metaplas$)).tw. | 6123 |
13 | or/9-12 | 16,985 |
14 | and/8,13 | 16 |
15 | exp animals/not humans/ | 4,698,916 |
16 | 14 not 15 | 16 |
Database | Embase | |
Platform | Elsevier | |
Years searched | 1947 - Present | |
Date last searched | May 18, 2020 | |
Limits | Humans (search hedge) | |
Number of results | 63 | |
Notes | ||
1 | ‘sleep disordered breathing’/exp | 79,097 |
2 | (sleep* NEAR/3 apn$ea*):ti,ab,kw | 63,570 |
3 | ‘hypopn$ea*’:ti,ab,kw | 20,426 |
4 | (hypoventilat* NEAR/3 (obes* OR obstruct*)):ti,ab,kw | 1537 |
5 | ‘pickwick*’:ti,ab,kw | 612 |
6 | ‘osa’:ti,ab,kw | 27,547 |
7 | ‘osahs’:ti,ab,kw | 2013 |
8 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 | 88,534 |
9 | ‘barrett esophagus’/de | 16,547 |
10 | (barret* NEAR/3 (dysplas* OR epitheli* OR esophagus* OR metaplas* OR musoca* OR oesophagus* OR syndrom*)):ti,ab,kw | 15,098 |
11 | (column* NEAR/3 (line* OR metaplas*)):ti,ab,kw | 3894 |
12 | (intestin* NEAR/3 (dysplas* OR metaplas*)):ti,ab,kw | 10,037 |
13 | #9 OR #10 OR #11 OR #12 | 28,820 |
14 | #8 AND #13 | 63 |
15 | [animals]/lim NOT [humans]/lim | 6,031,946 |
16 | #14 NOT #15 | 63 |
Database | Web of Science Core Collection (Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, Emerging Sources Citation Index) | |
Platform | Web of Science, Clarivate Analytics | |
Years searched | 1900 - Present | |
Date last searched | May 18, 2020 | |
Limits | None | |
Number of results | 42 | |
Notes | ||
1 | TOPIC: (sleep* NEAR/3 apn$ea*) | 49,544 |
2 | TOPIC: (hypopn$ea*) | 12,257 |
3 | TOPIC: (hypoventilat* NEAR/3 (obes* OR obstruct*)) | 1098 |
4 | TOPIC: (pickwick*) | 423 |
5 | TOPIC: (‘osa’) | 25,673 |
6 | TOPIC: (‘osahs’) | 846 |
7 | #6 OR #5 OR #4 OR #3 OR #2 OR #1 | 65,696 |
8 | TOPIC: (barret* NEAR/3 (dysplas* OR epitheli* OR esophagus* OR metaplas* OR musoca* OR oesophagus* OR syndrom*)) | 16,666 |
9 | TOPIC: (column* NEAR/3 (line* OR metaplas*)) | 5575 |
10 | TOPIC: (intestin* NEAR/3 (dysplas* OR metaplas*)) | 8005 |
11 | #10 OR #9 OR #8 | 26,830 |
12 | #11 AND #7 | 42 |
Database | CINAHL Complete | |
Platform | EBSCO | |
Years searched | 1937 - Present | |
Date last searched | May 18, 2020 | |
Limits | None | |
Number of results | 5 | |
Notes | ||
1 | (MH “Sleep Apnea Syndromes + ”) | 14,921 |
2 | (TI sleep* N3 apn#ea*) OR (AB sleep* N3 apn#ea*) | 13,211 |
3 | (TI hypopn#ea*) OR (AB hypopn#ea*) | 3415 |
4 | (TI hypoventilat* N3 (obes* OR obstruct*)) OR (AB hypoventilat* N3 (obes* OR obstruct*)) | 312 |
5 | (TI pickwick*) OR (AB pickwick*) | 39 |
6 | (TI ‘osa’) OR (AB ‘osa’) | 5498 |
7 | (TI ‘osahs’) OR (AB ‘osahs’) | 223 |
8 | S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 | 19,069 |
9 | (MH “Barrett Esophagus”) | 2038 |
10 | (TI barret* N3 (dysplas* OR epitheli* OR esophagus* OR metaplas* OR musoca* OR oesophagus* OR syndrom*)) OR (AB barret* N3 (dysplas* OR epitheli* OR esophagus* OR metaplas* OR musoca* OR oesophagus* OR syndrom*)) | 1884 |
11 | (TI column* N3 (line* OR metaplas*)) OR (AB column* N3 (line* OR metaplas*)) | 184 |
12 | (TI intestin* N3 (dysplas* OR metaplas*)) OR (AB intestin* N3 (dysplas* OR metaplas*)) | 615 |
13 | S9 OR S10 OR S11 OR S12 | 2930 |
14 | S8 AND S13 | 5 |
Database | Cochrane Central Register of Controlled Trials (CENTRAL) | |
Platform | Wiley | |
Years searched | All years | |
Date last searched | May 18, 2020 | |
Limits | None | |
Number of results | 3 | |
Notes | ||
1 | [mh “sleep apnea syndromes”] in Trials | 2526 |
2 | (sleep* NEAR/3 apn?ea*):ti,ab,kw in Trials | 6437 |
3 | (hypopn?ea*):ti,ab,kw in Trials | 2488 |
4 | (hypoventilat* NEAR/3 (obes* OR obstruct*)):ti,ab,kw in Trials | 167 |
5 | (pickwick*):ti,ab,kw in Trials | 19 |
6 | (‘osa’):ti,ab,kw in Trials | 2973 |
7 | (‘osahs’):ti,ab,kw in Trials | 184 |
8 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 in Trials | 7101 |
9 | [mh “barrett esophagus”] in Trials | 235 |
10 | (barret* NEAR/3 (dysplas* OR epitheli* OR esophagus* OR metaplas* OR musoca* OR oesophagus* OR syndrom*)):ti,ab,kw in Trials | 628 |
11 | (column* NEAR/3 (line* OR metaplas*)):ti,ab,kw in Trials | 41 |
12 | (intestin* NEAR/3 (dysplas* OR metaplas*)):ti,ab,kw in Trials | 369 |
13 | #9 OR #10 OR #11 OR #12 in Trials | 901 |
14 | #8 AND #13 in Trials | 3 |
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Elfanagely, Y., Atsawarungruangkit, A., Scharfen, J. et al. Association Between Obstructive Sleep Apnea and Barrett’s Esophagus: A Systematic Review and Meta-Analysis. Dig Dis Sci 66, 3689–3697 (2021). https://doi.org/10.1007/s10620-020-06709-1
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DOI: https://doi.org/10.1007/s10620-020-06709-1