Effect of Obstructive Sleep Apnea Hypopnea Syndrome on Lipid Profile: A Meta-Regression Analysis

Abstract

Background: Obstructive sleep apnea (OSA) is associated with obesity, metabolic syndrome, and dyslipidemia, which may be related to decrease androgen levels found in OSA patients. Dyslipidemia may contribute to atherosclerosis leading to increasing risk of heart disease. Methods: Systematic review was conducted using PubMed and Cochrane library by utilizing different combinations of key words; sleep apnea, obstructive sleep apnea, serum lipids, dyslipidemia, cholesterol, total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and triglyceride (TG). Inclusion criteria were: English articles, and studies with adult population in 2 groups of patients (patients with OSA and without OSA). A total 96 studies were reviewed for inclusion, with 25 studies pooled for analysis. Results: Sixty-four studies were pooled for analysis; since some studies have more than one dataset, there were 107 datasets with 18,116 patients pooled for meta-analysis. All studies measured serum lipids. Total cholesterol pooled standardized difference in means was 0.267 (p = 0.001). LDL cholesterol pooled standardized difference in means was 0.296 (p = 0.001). HDL cholesterol pooled standardized difference in means was -0.433 (p = 0.001). Triglyceride pooled standardized difference in means was 0.603 (p = 0.001). Meta-regression for age, BMI, and AHI showed that age has signifi cant effect for TC, LDL, and HDL. BMI had signifi cant effect for LDL and HDL, while AHI had signifi cant effect for LDL and TG. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is a common disorder affecting about 4% of middle-aged males and 2% of middle-aged women in the developed world and is a significant source of morbidity and mortality. 1,2 OSA is characterized by recurrent episodes of upper airway collapses during sleep. These recurrent episodes of upper airway collapse usually are accompanied by oxyhemoglobin desaturation and terminated by brief arousals which result in marked sleep fragmentation and chronic excessive daytime sleepiness (EDS). 1,2 OSA has been increasingly linked to cardiovascular and cerebrovascular disease, and many studies have shown that OSA is associated with increased cardiovascular and cerebrovascular morbidity. 3-9 OSA is associated with obesity and metabolic syndrome. 10 Multiple studies addressing this interesting and complex issue are available where lipid profi le was measured in subjects with OSA. We performed metaanalysis (MA) and meta-regression (MR) to specifi cally detect if OSA adversely affects degree of dyslipidemia; elevation of total cholesterol (TC), low density lipoprotein cholesterol (LDL), triglyceride (TG), and reduces level of high density lipoprotein cholesterol (HDL). Effect of Obstructive Sleep Apnea Hypopnea Syndrome on METHODS Data Source and Study SelectionStudies for review were found searching the PubMed, Cochrane, and EMBASE databases from January 01, 196801, , to November 30th, 2013. Unpublished data from scientifi c meetings were not searched, since...

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

“…45 AHI correlated positively with triglyceride levels and negatively with HDL levels but not with total cholesterol or LDL. 45 The association between OSA/AHI and triglyceride levels was also evident in non-obese patients 34 suggesting that relationship is independent of obesity and possibly more related to IR. However, despite these findings, a good evidence of causality between OSA and hyperlipidaemia is lacking, although mechanistically it is plausible that chronic intermittent hypoxia might lead to hyperlipidaemia via the generation of stearoylcoenzyme A desaturase-1 and oxidative stress, peroxidation of lipids and sympathetic activation.…”

“…The results are conflicting mainly due to differences in the population examined (particularly the choice of the control group, the sample size and the possible confounding effects of CPAP). 45,46 A recent meta-analysis of 64 studies showed that OSA was associated with higher total cholesterol, higher low-density lipoprotein (LDL), higher triglycerides and lower high-density lipoprotein (HDL). 45 AHI correlated positively with triglyceride levels and negatively with HDL levels but not with total cholesterol or LDL.…”

“…45,46 A recent meta-analysis of 64 studies showed that OSA was associated with higher total cholesterol, higher low-density lipoprotein (LDL), higher triglycerides and lower high-density lipoprotein (HDL). 45 AHI correlated positively with triglyceride levels and negatively with HDL levels but not with total cholesterol or LDL. 45 The association between OSA/AHI and triglyceride levels was also evident in non-obese patients 34 suggesting that relationship is independent of obesity and possibly more related to IR.…”

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“…57 However, cross-sectional studies were not consistent mainly due to differences in the population examined, study designs and the impact of CPAP. 57,58 A meta-analysis of 64 studies showed that OSA was associated with higher total cholesterol, higher low-density lipoprotein (LDL), higher triglycerides and lower high-density lipoprotein (HDL), while AHI correlated positively with triglycerides and negatively with HDL levels only. 58 The association between OSA/AHI and triglycerides is obesity independent.…”

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“…24 Further, a large 2015 cross-sectional study demonstrated an independent association between OSA and elevated LDL. 25 The association between OSA and dyslipidemia may mediate some of the excess cardiovascular morbidity and mortality risk associated with OSA.…”