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

Liang Xie, Penghao Zhen, Fuchao Yu, Xiaojin Yu, Hai Qian, Fang Yang, Jiayi Tong

Journal: Sleep & breathing = Schlaf & Atmung 2022;26(1):5-15

PMID: 33772396

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.

Address: School of Medicine, Southeast University, Nanjing, China.; Jinling Hospitial, School of Medicine, Nanjing University, Nanjing, China.; Department of Cardiology, Zhongda Hospital, Nanjing, China.; School of Public Health, Southeast University, 87 Dingjiaqiao, Nanjing, China.; Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.; State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biomedical Sciences and Medical Engineering, Southeast University, Nanjing, China.; School of Medicine, Southeast University, Nanjing, China. [email protected].; Department of Cardiology, Zhongda Hospital, Nanjing, China. [email protected].

DOI: 10.1007/s11325-021-02294-3