SLEEP APNEA AS A RISK FACTOR FOR DIASTOLIC DYSFUNCTION: A SYSTEMATIC
REVIEW AND META-ANALYSIS
Abstract
Abstract: Background: This meta-analysis assessed the relationship
between Obstructive Sleep Apnea (OSA) and echocardiographic parameters
of diastolic dysfunction (DD), which are used in the assessment of Heart
Failure with Preserved Ejection Fraction (HFpEF). Methods: We searched
the databases including Ovid MEDLINE, Ovid Embase Scopus, Web of
Science, Google Scholar, and EBSCO CINAHL from inception up to December
26th, 2020. The search was not restricted to time, publication status or
language. Comparisons were made between patients with OSA, diagnosed
in-laboratory polysomnography (PSG) or home sleep apnea testing (HSAT),
and patients without OSA in relation to established markers of diastolic
dysfunction. Results: Primary search identified 2512 studies. A total of
18 studies including 2509 participants were included. The two groups
were free of conventional cardiovascular risk factors. Significant
structural changes were observed between the two groups. Patients with
OSA exhibited greater LAVI (3.94 CI [0.8, 7.07]; p=0.000) and left
ventricular mass index (11.10 CI [2.56,19.65]; p=0.000) as compared
to control group. The presence of OSA was also associated with more
prolonged DT (10.44 ms CI [0.71,20.16]; p=0.04), IVRT (7.85 ms
CI[4.48, 11.22]; p=0.000), and lower E/A ratio (-0.62 CI
[-1,-0.24]; p=0.001) suggestive of early DD. The E/e’ ratio (0.94
CI[0.44, 1.45]; p=0.000) was increased. Conclusion: An association
between OSA and echocardiographic parameters of DD was detected that was
independent of conventional cardiovascular risk factors. OSA may be
independently associated with DD perhaps due to higher LV mass.
Investigating the role of CPAP therapy in reversing or ameliorating
diastolic dysfunction is recommended.