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Meta-Analysis
. 2020 Aug;29(4):e13046.
doi: 10.1111/jsr.13046. Epub 2020 Apr 15.

Obstructive sleep apnea is associated with coronary microvascular dysfunction: A systematic review from a clinical perspective

Rui-Heng Zhang #  1 , Wei Zhao #  2 , Lin-Ping Shu  1 , Nan Wang  1 , Yao-Hua Cai  1 , Jin-Kui Yang  3 , Jian-Bo Zhou  1 , Lu Qi  4
Affiliations
Meta-Analysis

Obstructive sleep apnea is associated with coronary microvascular dysfunction: A systematic review from a clinical perspective

Rui-Heng Zhang et al. J Sleep Res. 2020 Aug.

Abstract

There is now increasing evidence demonstrating that obstructive sleep apnea (OSA) contributes to microvascular disorder. However, whether OSA is associated with impaired coronary flow reserve is still unclear. Therefore, we conducted this systematic review and meta-analysis to summarize current evidence. In a systematic review, PubMed, Embase, the Cochrane Library and Web of Science were searched; five observational studies fulfilled the selection criteria and were included in this study. Data were extracted from selected studies and meta-analysis was performed using random-effects modelling. In all, 829 OSA patients and 507 non-OSA subjects were included and assessed for coronary flow reserve (CFR), the clinical indicator of coronary microvascular dysfunction (CMD). For all studies, OSA was significantly associated with reduced CFR. The pooled weighted mean difference (WMD) of CFR was -0.78 (95% confidence interval [CI] -1.25 to -0.32, p ＜ 0.001, I2 = 84.4%). The difference in the apnea-hypopnea index (AHI) between studies can explain 89% of heterogeneity (coef = -0.05, 95% CI -0.12 to 0.02, p = .078) in a meta-regression, indicating the CFR tended to negatively correlate with severity of OSA. The Egger regression test did not show statistical significance (p = .49). In conclusion, there are plausible biological mechanisms linking OSA and CMD, and the preponderance of evidence from this systematic review suggests that OSA, especially severe OSA, is associated with reduced CFR. Future studies are warranted to further delineate the exact role of OSA in CMD occurrence and development in a prospective setting.

Keywords: coronary flow reserve; meta-analysis; obstructive sleep apnea.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart summarizing study identification and selection
FIGURE 2
FIGURE 2
Forest plot and pooled estimates of the effect of obstructive sleep apnea (OSA) on coronary flow reserve (CFR). WMD, weighted mean difference
FIGURE 3
FIGURE 3
Funnel plot of standard error by weighted mean difference (WMD) for coronary flow reserve (CFR). Egger's regression test: p‐value = .49. se, standard error
See this image and copyright information in PMC

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