Obstructive sleep apnoea syndrome and left ventricular hypertrophy: a meta-analysis of echocardiographic studies

Cuspidi, Cesare; Tadić, Marijana; Sala, Carla; Gherbesi, Elisa; Mancia, Giuseppe

doi:10.1097/hjh.0000000000002435

Cited by 29 publications

(21 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Night-time blood pressure is a strong predictor of cardiovascular diseases (CVD) [56,57]. The severity of OSA has been associated with the risk of left ventricular hypertrophy [58]. Consequently, management of blood pressure is important to prevent CVD in patients with OSA.…”

Section: Discussionmentioning

confidence: 99%

Effect of different treatments for obstructive sleep apnoea on blood pressure

Kou¹,

Zhao²,

Lin³

et al. 2022

Journal of Hypertension

View full text Add to dashboard Cite

Objective: Obstructive sleep apnoea (OSA) is a common cause of secondary hypertension. This network metaanalysis (NMA) assessed the effect of different OSA treatments on lowering blood pressure.Methods: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for relevant randomized controlled trials. The search strategies included the concepts of OSA, blood pressure, hypertension, and blood pressure-reducing treatments without language or data restriction (from inception to 1 June 2021). The outcomes included office SBP, office DBP, daytime SBP (dSBP) and DBP (dDBP), and night-time SBP (nSBP) and DBP (nDBP). A Bayesian network meta-analysis was performed, and mean differences with 95% credibility intervals were calculated.Results: We reviewed 49 randomized controlled trials involving 4893 patients and the following interventions: continuous positive-airway pressure (CPAP), mandibular advancement devices, nocturnal supplemental oxygen, surgery, b-blocker, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), renal sympathetic denervation (RDN), mineralocorticoid receptor antagonists (MRAs), calcium channel blockers. MRAs were significantly associated with blood pressure reduction followed by ACEI/ARB. RDN could reduce office SBP, office DBP, 24-h SBP, 24-h DBP, dSBP, and dDBP. CPAP also demonstrated modest blood pressure lowering. Conclusion:MRAs and ACEIs/ARBs can reduce blood pressure effectively in patients with OSA. RDN is a novel hypertension treatment that lowered blood pressure in such patients. CPAP was associated with mild but stable blood pressure reduction, and it might be helpful as an adjunctive therapy in OSA patients with hypertension.Review registration: This systematic review and metaanalysis was registered in PROSPERO: CRD42021240891.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of different treatments for obstructive sleep apnoea on blood pressure

Kou¹,

Zhao²,

Lin³

et al. 2022

Journal of Hypertension

View full text Add to dashboard Cite

show abstract

“…Compared to controls, the OSA group exhibited an increased risk of both concentric (OR = 1.62, CI: 1.27-2.07) and eccentric (OR = 1.34, CI: 1.07-1.67) LVH. Finally, a large meta-analysis of our group (5550 patients with OSA and 2329 non-OSA controls from 39 studies) showed that the likelihood of developing LVH increases with the severity of the syndrome with a continuous relationship [35] (Table 1).…”

Section: Left Ventricular Hypertrophy (Lvh)mentioning

confidence: 92%

Targeting subclinical organ damage in obstructive sleep apnea: a narrative review

et al. 2020

Self Cite

View full text Add to dashboard Cite

Subclinical abnormalities in cardiac and vascular structure reflect the adverse effects triggered by a variety of risk factors on the cardiovascular (CV) system thereby representing an intermediate step in the cardiovascular continuum; such alterations are recognized as reliable markers of increased cardiovascular risk in different clinical settings including obstructive sleep apnea (OSA). The mechanisms underlying subclinical organ damage (OD) in the OSA setting are multifactorial. Hypoxemia and hypercapnia, induced by repeated collapses of upper airways, have been suggested to trigger a cascade of events such as activation of the sympathetic tone, renin-angiotensin-aldosterone system leading to endothelial dysfunction, vasoconstriction, myocardial and vascular remodeling, and hypertension. Furthermore, coexisting non-haemodynamic alterations such as increased oxidative stress, release of inflammatory substances, enhanced lipolysis and insulin resistance have been reported to play a role in the pathogenesis of both cardiac and extra-cardiac OD. In this article we reviewed available evidence on the association between OSA and subclinical cardiac (i.e., left and right ventricular hypertrophy, left atrial dilatation) and extracardiac organ damage (i.e., carotid atherosclerosis, arterial stiffness, microvascular retinal changes, and microalbuminuria). This association is apparently stronger for cardiac and carotid subclinical damage than for other markers (i.e., arterial stiffness and retinal changes) and mostly evident in the setting of severe OSA.

show abstract

“…During the past two decades, numerous experimental and clinical reports have considered IH to be the main contributor to OSA-associated cardiovascular complications and mortality [ 4 – 6 ]. Systematic reviews and meta-analyses have reported that OSA patients exhibit increased left ventricular (LV) hypertrophy, dilation and subclinical markers of LV diastolic dysfunction in accordance with the severity of IH [ 7 – 9 ]. OSA-associated cardiac remodelling results in impaired LV systolic function ( i.e.…”

Section: Introductionmentioning

confidence: 99%

Cardiac consequences of intermittent hypoxia: a matter of dose? A systematic review and meta-analysis in rodents

et al. 2022

View full text Add to dashboard Cite

AimIntermittent hypoxia (IH) is considered to be a major contributor to obstructive sleep apnoea-related cardiovascular consequences. The present meta-analysis aimed to assess the effects of IH on cardiac remodelling, function and infarct size after myocardial ischaemia across different rodent species and IH severities.Methods and resultsRelevant articles from PubMed, Embase and Web of Science were screened. We performed a random effect meta-analysis to assess the effect of IH on myocardium in rodents by using standardised mean difference (SMD). Studies using rodents exposed to IH and outcomes related to cardiac remodelling, contractile function and response to myocardial ischaemia–reperfusion were included. 5217 articles were screened and 92 were included, demonstrating that IH exposure induced cardiac remodelling, characterised by cardiomyocyte hypertrophy (cross-sectional area: SMD=2.90, CI (0.82–4.98), I2=94.2%), left ventricular (LV) dilation (LV diameter: SMD=0.64, CI (0.18–1.10), I2=88.04%), interstitial fibrosis (SMD=5.37, CI (3.22–7.53), I2=94.8) and apoptosis (terminal deoxynucleotidyl transferase dUTP nick end labelling: SMD=6.70, CI (2.96–10.44), I2=95.9). These structural changes were accompanied by a decrease in LV ejection fraction (SMD=−1.82, CI (−2.52–−1.12), I2=94.22%). Importantly, most of the utilised IH protocols mimicked extremely severe hypoxic disease. Concerning infarct size, meta-regression analyses highlighted an ambivalent role of IH, depending on its severity. Indeed, IH exposure with inspiratory oxygen fraction (FIO2) <7% was associated with an increase in infarct size, whereas a reduced infarct size was reported for FIO2 levels above 10%. Heterogeneity between studies, small study effect and poor reporting of methods in included articles limited the robustness of the meta-analysis findings.ConclusionThis meta-analysis demonstrated that severe IH systematically induces cardiac remodelling and contractile dysfunction in rodents, which might trigger or aggravate chronic heart failure. Interestingly, this meta-analysis showed that, depending on stimulus severity, IH exhibits both protective and aggravating effects on infarct size after experimental ischaemia–reperfusion procedures.

show abstract

Obstructive sleep apnoea syndrome and left ventricular hypertrophy: a meta-analysis of echocardiographic studies

Cited by 29 publications

References 58 publications

Effect of different treatments for obstructive sleep apnoea on blood pressure

Effect of different treatments for obstructive sleep apnoea on blood pressure

Targeting subclinical organ damage in obstructive sleep apnea: a narrative review

Cardiac consequences of intermittent hypoxia: a matter of dose? A systematic review and meta-analysis in rodents

Contact Info

Product

Resources

About