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

Content Provider	Europe PMC
Author	Zhang, Rui‐Heng Zhao, Wei Shu, Lin‐Ping Wang, Nan Cai, Yao-Hua Yang, Jin‐Kui Zhou, Jian‐Bo Qi, Lu
Abstract	AbstractThere 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.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7685100&blobtype=pdf
Page Count	8
ISSN	09621105
Journal	Journal of Sleep Research [J Sleep Res]
Volume Number	29
DOI	10.1111/jsr.13046
PubMed Central reference number	PMC7685100
Issue Number	4
PubMed reference number	32293774
e-ISSN	13652869
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2020-04-15
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2020 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.
Subject Keyword	coronary flow reserve meta‐analysis obstructive sleep apnea
Content Type	Text
Resource Type	Article
Subject	Cognitive Neuroscience Behavioral Neuroscience Medicine