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

• Published in: Sleep & breathing 2022-03, Vol.26 (1), p.5-15
• Main Authors: Xie, Liang, Zhen, Penghao, Yu, Fuchao, Yu, Xiaojin, Qian, Hai, Yang, Fang, Tong, Jiayi
• Format: Article
• Language: English
• Subjects: Apnea; Biomarkers; Calcium-binding protein; Cardiovascular Diseases - epidemiology; Comorbidity; Creatine; Creatine kinase; Dentistry; Heart; Humans; Hypoxia; Inflammation - epidemiology; Internal Medicine; Ischemia; Medicine; Medicine & Public Health; Meta-analysis; Neurology; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Risk Factors; Sleep; Sleep apnea; Sleep Apnea Syndromes - epidemiology; Sleep Apnea, Obstructive - epidemiology; Sleep Breathing Physiology and Disorders • Review; Sleep disorders; Systematic review; Troponin
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-021-02294-3

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.