关键词: Atherosclerosis Cardiac dysfunction Cardiac remodeling Coronary artery calcium Coronary plaque Obstructive sleep apnea

Mesh : Diagnostic Imaging Humans Sleep Apnea, Obstructive / complications Stroke Volume Ventricular Function, Left

来  源:   DOI:10.1186/s13643-021-01759-6   PDF(Sci-hub)   PDF(Pubmed)

Abstract:
We aimed to perform a systematic review and meta-analysis of the association between obstructive sleep apnea (OSA) and cardiac as well as coronary impairment evaluated using imaging modalities. Finding of this study will provide more robust evidence regarding OSA-induced cardiovascular damage.
We systematically searched through PubMed, EMBASE, and Cochrane library databases for relevant literatures on the association between OSA and cardiovascular damage evaluated using imaging modalities, and manually searched the references of selected articles for additional relevant articles. For each clinical parameter relevant to the meta-analysis, we first evaluated the methodological heterogeneity of the relevant studies and thereafter pooled the data together using fixed effect or random effect model. The difference in the relevant indices of cardiovascular damage between OSA patients and controls was evaluated using the standardized mean difference.
Of the 82 articles included in the final systematic analysis, 20 studies explored the association between OSA and coronary atherosclerosis. OSA patients had higher rate of coronary atherosclerosis assessed by coronary artery calcification score and plaque volume. Moreover, the severity of OSA and coronary atherosclerosis displayed a positive correlation. The rest of the studies (n = 62) evaluated cardiac alterations in OSA patients. According to the inclusion and exclusion criteria, 46 studies yielding 3082 OSA patients and 1774 controls were pooled for the meta-analysis. For left cardiac structure and function, OSA patients exhibited significantly wider left atrial diameter; higher left atrium volume index; wider left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and left ventricular mass; higher left ventricular mass index; wider interventricular septum diameter and posterior wall diameter; and higher left ventricular myocardial performance index (all p < 0.05). In addition, compared with controls, left ventricular ejection fraction was significantly decreased in OSA patients (p = 0.001). For right cardiac structure and function, OSA patients displayed a significant increase in right ventricular diameter and right ventricular myocardial performance index (both p < 0.001). Finally, compared with controls, OSA patients displayed significant decrease in tricuspid annular plane systolic excursion and RV fractional area change (p = 0.001).
Overall, this systematic review and meta-analysis provides imaging evidence in support that OSA patients are at a higher risk of developing coronary atherosclerosis and display cardiac remodeling and dysfunction.
摘要:
我们旨在对阻塞性睡眠呼吸暂停(OSA)与使用成像方式评估的心脏和冠状动脉损害之间的关系进行系统评价和荟萃分析。这项研究的发现将为OSA引起的心血管损害提供更有力的证据。
我们系统地搜索了PubMed,EMBASE,和Cochrane图书馆数据库中有关OSA与心血管损害之间关联的相关文献,使用成像方式进行评估,并手动搜索选定文章的参考文献以查找其他相关文章。对于与荟萃分析相关的每个临床参数,我们首先评估了相关研究的方法学异质性,然后使用固定效应或随机效应模型将数据汇总.OSA患者和对照组之间心血管损害相关指标的差异使用标准化平均差异进行评估。
在最终系统分析的82篇文章中,20项研究探讨了OSA与冠状动脉粥样硬化之间的关系。通过冠状动脉钙化积分和斑块体积评估OSA患者的冠状动脉粥样硬化发生率较高。此外,OSA的严重程度与冠状动脉粥样硬化呈正相关。其余的研究(n=62)评估了OSA患者的心脏改变。根据纳入和排除标准,收集了3082例OSA患者和1774例对照的46项研究进行荟萃分析。对于左心结构和功能,OSA患者左心房内径明显变宽,左心房容积指数变高,左心室收缩末期内径变宽,左心室舒张末期直径,和左心室质量;较高的左心室质量指数;较宽的室间隔直径和后壁直径;和较高的左心室心肌性能指标(均p<0.05)。此外,与对照组相比,OSA患者左心室射血分数显著降低(p=0.001).对于正确的心脏结构和功能,OSA患者右心室内径和右心室心肌功能指数均显著增加(P均<0.001)。最后,与对照组相比,OSA患者三尖瓣环平面收缩偏移和RV面积变化显着降低(p=0.001)。
总的来说,本系统综述和荟萃分析提供了影像学证据,支持OSA患者发生冠状动脉粥样硬化的风险较高,并表现出心脏重塑和功能障碍.
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