Epicardial Adipose Tissue in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Objective: Epicardial adipose tissue (EAT) is a potential risk factor for obstructive sleep apnea (OSA). We performed a meta-analysis to assess the association of EAT with OSA.Methods: The PubMed, EMBASE, Web of Science, Cochrane Library, and Wanfang databases were searched by two independent investigators for all observational studies assessing the association of EAT with OSA. Then we assessed the association of EAT thickness (EAT-t) and EAT volume (EAT-v) with OSA by a meta-analysis.Results: Ten studies were included in the final analysis. Compared with that in controls, EAT-t in OSA patients was significantly increased (standardized mean difference 0.88, 95% confidence interval 0.72‐1.05, P=0.000). Furthermore, EAT-t was greater in OSA patients than in controls with similar BMIs. However, we did not find significant differences in EAT-v between OSA patients and controls (standardized mean difference 2.46, 95% confidence interval −0.36 to 5.29, P=0.088). EAT-t in the mild, moderate, and severe OSA subgroups was greater than in the controls. In addition, there were significant differences in EAT-t among the mild, moderate, and severe OSA subgroups.Conclusions: EAT-t was greater in patients with OSA than in controls, and EAT-t was also associated with the severity of OSA. These findings may provide a new clue for the pathogenesis and treatment of OSA.

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Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies

Vascular ◽

10.1177/1708538118766102 ◽

2018 ◽

Vol 26 (5) ◽

pp. 515-523 ◽

Cited By ~ 3

Author(s):

Xiushi Zhou ◽

Fei Liu ◽

Wei Zhang ◽

Guili Wang ◽

Daqiao Guo ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Aortic Dissection ◽

Confidence Interval ◽

Mean Difference ◽

Cochrane Library ◽

Severe Obstructive Sleep Apnea ◽

Odds Ratios ◽

Sleep Study ◽

Obstructive Sleep

Objectives Obstructive sleep apnea acts as a potential risk factor for the development of cardiovascular disease. We undertook collaborative meta-analyses to clarify the risk of aortic dissection among adults suffering obstructive sleep apnea. Methods A systematic search of the databases (PubMed, Embase, and Cochrane Library) was performed. Studies reporting on the association between obstructive sleep apnea and aortic dissection were included. Information on 424 cases of aortic dissection in 56,291 patients from one cohort, four case–controls, and two cross-sectional studies were included in this study. Results The summary suggested that patients with obstructive sleep apnea are associated with an overall significant 60% increase in the risk of aortic dissection, compared to unexposed patients (odds ratios 1.60; 95% confidence interval 1.01–2.53), with a significantly higher apnea–hypopnea index (mean difference 10.71; 95% confidence interval 7.46–13.96). Moreover, a greater relation was found between moderate-to-severe obstructive sleep apnea and aortic dissection (odds ratios 4.43; 95% confidence interval 2.59–7.59). Adverse outcomes obtained by sleep study such as oxygen desaturation index (mean difference 10.51; 95% confidence interval 7.54–13.48), average SaO2 (−1.36; 95% confidence interval −2.63 to −0.09), and minimum SaO2 (−3.63; 95% confidence interval −5.27 to −1.98) were correspondingly related to patients with aortic dissection. Conclusions Obstructive sleep apnea, especially moderate-to-severe obstructive sleep apnea, may impose an additional risk of suffering from aortic dissection with a potential mechanism including intermittent hypoxia.

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The effect of non-benzodiazepine sedative hypnotics on CPAP adherence in patients with OSA: a systematic review and meta-analysis

SLEEP ◽

10.1093/sleep/zsab077 ◽

2021 ◽

Author(s):

Donghao Wang ◽

Yongkang Tang ◽

Yanghang Chen ◽

Sun Zhang ◽

Danjie Ma ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Cpap Adherence ◽

Randomized Controlled ◽

Obstructive Sleep ◽

Sedative Hypnotics

Abstract Study objectives This meta-analysis aimed to explore the effect of non-benzodiazepine sedative hypnotics (NBSH) on continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA). Methods We conducted a systematic search through PubMed, Medline, the Cochrane Library, EMBASE, Scopus and ClinicalTrials (all searched from inception to 15 August 2020). Publications were limited to articles, clinical conferences and letters, including randomized controlled trials and retrospective studies. We used a random-effects model to calculate the odds ratio (OR) and mean difference (MD) with corresponding confidence interval (CI). Subgroup analyses were conducted to analyze the sources of heterogeneity. Results Eight studies fulfilled the inclusion and exclusion criteria for patients newly diagnosed with obstructive sleep apnea. Overall, the use of NBSH was associated with increased use of CPAP per night (MD = 0.62 h; 95% CI = 0.26-0.98) and use for more nights (MD = 12.08%; 95% CI = 5.27-18.88). When a study seriously affecting heterogeneity was removed, more patients adhered well with CPAP use (pooled OR = 2.48; 95% CI = 1.75-3.52) with good adherence defined as CPAP use for＞4 h/night on＞70% of nights. Among prescribed NBSHs, eszopiclone showed the most significant effect on CPAP adherence. Conclusion CPAP adherence may increase in OSA patients treated with non-benzodiazepine sedative hypnotics especially eszopiclone. The effect of zolpidem and zaleplon on CPAP adherence requires further investigation by larger scale, randomized, controlled trials.

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Metoprolol Inhibits Profibrotic Remodeling of Epicardial Adipose Tissue in a Canine Model of Chronic Obstructive Sleep Apnea

Journal of the American Heart Association ◽

10.1161/jaha.118.011155 ◽

2019 ◽

Vol 8 (3) ◽

Cited By ~ 4

Author(s):

Hui Dai ◽

Yue Yuan ◽

Shuangli Yin ◽

Yun Zhang ◽

Yu Han ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Adipose Tissue ◽

Sleep Apnea ◽

Epicardial Adipose Tissue ◽

Canine Model ◽

Chronic Obstructive ◽

Obstructive Sleep

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Effectiveness of Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea (Meta-analytic Study)

QJM ◽

10.1093/qjmed/hcaa047.003 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M Mahmoud ◽

A Mohamed ◽

H Nasr

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Outcome Measures ◽

Nerve Stimulation ◽

Primary Outcome ◽

Hypoglossal Nerve ◽

Mean Difference ◽

Hypoglossal Nerve Stimulation ◽

Obstructive Sleep ◽

Standardized Mean Difference

Abstract Background Obstructive sleep apnea (OSA) is a serious, potentially life-threatening disorder. There are many treatment modalities are being used, but none of them gained consensus. Continuous positive airway pressure considered the most widely accepted treatment of OSA but very poor adherence limits its effectiveness, thus was the need for alternative therapy of high compliance and effective for long term. Aim of the Work To perform a meta-analysis of the available studies included outcomes of hypoglossal nerve stimulation to evaluate its effectiveness as a choice of treatment of obstructive sleep apnea. Patients and Methods The study included published medical articles that evaluated the efficacy of hypoglossal nerve stimulation as treatment of obstructive sleep apnea with outcomes for primary outcome measures apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and for secondary outcome measures Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ) before and after implantation. Results Eight prospective studies with 329 patients were included in this met analysis. At 12 months, statistical analysis demonstrated significant reductions in AHI, ODI with standardized mean difference of -1.3940 (95% CI: -1.7745 to -1.0136; P = 0.0042), -0.9188 (95% CI: -1.3040 to -0.5337; p = 0.0002) respectively, and -not significant- reduction in ESS, FOSQ with standardized mean difference of -1.0365 (95% CI: -1.1889 to -0.8841; p = 0.2290), 1.0545 (95% CI: 0.8867 to 1.2223; p = 0.4922), respectively. Similar were observed at 6 months. Conclusion Hypoglossal nerve stimulation results in significant improvement of primary outcome measures of OSA with significant reduction of apnea episodes. It could be considered as an effective -but still of high cost- alternative for OSA patients. Further studies comparing HNS to other therapies are needed.

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Effects of CPAP on visceral adipose tissue in patients with obstructive sleep apnea: a meta-analysis

Sleep And Breathing ◽

10.1007/s11325-019-01932-1 ◽

2019 ◽

Vol 24 (2) ◽

pp. 425-432

Author(s):

Qingshi Chen ◽

Guofu Lin ◽

Jiefeng Huang ◽

Lida Chen ◽

Chaowei Li ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Adipose Tissue ◽

Sleep Apnea ◽

Visceral Adipose Tissue ◽

Meta Analysis ◽

Obstructive Sleep ◽

Visceral Adipose

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Patients with Obstructive Sleep Apnea Display Increased Carotid Intima Media: A Meta-Analysis

International Journal of Vascular Medicine ◽

10.1155/2013/839582 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Rashid Nadeem ◽

Michael Harvey ◽

Mukesh Singh ◽

Ahmed Abdullah Khan ◽

Mustafa Albustani ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Meta Analysis ◽

Adult Population ◽

Intima Media Thickness ◽

Cochrane Library ◽

Apnea Hypopnea Index ◽

Data Set ◽

Media Thickness ◽

Obstructive Sleep

Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT).Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis.Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from −0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, (P<0.0001).Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process.

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Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: A systematic review and meta-analysis

The Angle Orthodontist ◽

10.2319/111117-770.1 ◽

2018 ◽

Vol 88 (4) ◽

pp. 483-493 ◽

Cited By ~ 11

Author(s):

Igor Felipe Pereira Lima ◽

Walbert de Andrade Vieira ◽

Ítalo de Macedo Bernardino ◽

Pedro Augusto Costa ◽

Anderson Paulo Barbosa Lima ◽

...

Keyword(s):

Confidence Interval ◽

Orthodontic Treatment ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Mean Difference ◽

Plaque Index ◽

Cochrane Library ◽

Gingival Index ◽

White Spots ◽

Standardized Mean Difference

ABSTRACT Objective: To assess the scientific evidence regarding the influence of reminder therapy on plaque index, gingival index, and white spots in patients subjected to orthodontic treatment. Materials and Methods: Randomized clinical trials were searched in the electronic databases LILACS, PubMed, SciELO, Scopus, Web of Science, Embase, LIVIVO, and Cochrane Library. The databases OpenThesis and OpenGrey were used to capture the “gray literature,” preventing selection and publication biases. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials tool. The software Review Manager was used for the meta-analysis. The heterogeneity among studies was assessed through the I2 statistic. A summary of the overall strength of evidence available was assessed using the Grades of Recommendations Assessment, Development, and Evaluation tool. Results: A total of 332 records were found, from which only 7 articles met the inclusion criteria and were subjected to analysis. Reminder therapy showed improved scores for the plaque index (standardized mean difference = −1.22; 95% confidence interval = −2.03 to −0.42; P = .003) and the gingival index (standardized mean difference = 1.49; 95% confidence interval = −2.61 to 0.37; P = .009). Moreover, there was lower occurrence of white spots (relative risk = 0.53; 95% confidence interval = 0.38 to 0.74; P < .001) when reminder therapy was implemented. Conclusions: According to the existing high-quality evidence, reminder therapy is a valuable strategy and may contribute to the reduction of plaque and gingival indices as well as to the lower occurrence of white spots in patients subjected to orthodontic treatment.

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The efficacy and safety of intravaginal oxytocin on vaginal atrophy: A systematic review

Post Reproductive Health ◽

10.1177/2053369120946645 ◽

2020 ◽

pp. 205336912094664

Author(s):

Zahra Ghorbani ◽

Mojgan Mirghafourvand

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Fixed Effects ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Vaginal Atrophy ◽

Suitable Alternative ◽

Statistical Heterogeneity ◽

Standardized Mean Difference

Genitourinary syndrome of menopause is a major issue in menopausal health. Because unlike vasomotor symptoms, it has a progressive trend. In this regard we conducted a systematic review to evaluate the efficacy of intravaginal oxytocin on postmenopausal vaginal atrophy. A search was performed for published studies in Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar and Persian databases without time and language limitations. Only randomized controlled trials that compared intravaginal oxytocin with placebos were included. The outcome measures were objective and subjective assessed symptoms of vaginal atrophy. Statistical heterogeneity was evaluated using the I2. The standardized mean differences were pooled the fixed effects model. Of the five included studies, four studies meta-analysed. The meta-analysis in terms of the cytological analysis (standardized mean difference: 35.13, 95% confidence interval: 32.59–37.67, n = 218, I2 = 96%) was statistically significant. In terms of histological assessments (standardized mean difference: −0.38, 95% confidence interval: −0.94 to 0.17, n = 38, I2 = 0%) and endometrial thickness (standardized mean difference: 0.05, 95% confidence interval: −0.20 to −0.31, n = 95, I2 = 0%), there were no statistically significant differences between the groups. Three studies reported a statistically significant improvement in the subjective symptoms; however, we were unable to perform a meta-analysis. Four of the included studies assessed side effects, but only two studies reported them. Oxytocin as a nonestrogenic compound can be a suitable alternative for the treatment of vaginal atrophy, especially in women with contraindications for using estrogenic compounds. Further good quality clinical trials with long-term follow-ups are recommended to demonstrate the effects of intravaginal gel in the treatment of vaginal atrophy.

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Prothrombotic Factors in Obstructive Sleep Apnea: A Systematic Review With Meta-Analysis

Ear Nose & Throat Journal ◽

10.1177/0145561320965208 ◽

2020 ◽

pp. 014556132096520

Author(s):

Yue Qiu ◽

Xiaodan Li ◽

Xin Zhang ◽

Wei Wang ◽

Jun Chen ◽

...

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Meta Analysis ◽

Plasminogen Activator Inhibitor ◽

Cochrane Library ◽

Plasminogen Activator Inhibitor 1 ◽

Obstructive Sleep ◽

Mean Differences ◽

The Relationship

Background: Previous studies revealed that the prothrombotic factors in patients with obstructive sleep apnea (OSA) remain controversial. Aim/Objective: The aim of the systematic review is to elucidate the relationship between prothrombotic factors and OSA. Materials and Methods: This systematic review was performed under the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The literature we investigated was extracted from 4 main medical databases (PubMed, Web of Science, Cochrane Library, and Chinese databases) as of February 2020. We used significant weighted mean differences (SMDs) with 95% CIs from random-effects model. Results: A total of 15 studies comprising 2190 patients were available for the meta-analysis. The pooled results showed that the levels of fibrinogen (SMD = 0.95, 95% CI = 0.26 to 1.65, P = .000), vascular endothelial growth factor (SMD = 0.37, 95% CI = −0.90 to 1.63, P = .000), and plasminogen activator inhibitor 1 (SMD = 0.61, 95% CI = 0.29 to 0.92, P = .040) increased in patients with OSA. There were no statistical differences between groups in terms of d-dimer ( P = .108) and platelet counts ( P = .233). Subgroup analyses demonstrated that specimen types and age could account for the heterogeneity. Conclusions and Significance: This meta-analysis indicated the relationship between prothrombotic factors in OSA hypopnea. Obstructive sleep apnea–related effects may underline the importance of considering the dysfunction of the hemostatic system. The prothrombotic factors in OSA can influence making a choice of appropriate therapy.

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