Faculty of Medicine, Department of Biochemistry, Maheshwara Medical College & Hospital, Near Patancheru, Hyderabad, Telangana, 502307, India.
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Sleep Breath. 2019 Mar;23(1):179-191. doi: 10.1007/s11325-018-1679-6. Epub 2018 Jun 14.
A close association of oxidative stress (OS) and ischemia-modified albumin (IMA) with obstructive sleep apnea (OSA) has been reported in the literature, but the results on IMA are ambiguous. We conducted a meta-analysis to evaluate the association of IMA with OSA and the effect of continuous positive airway pressure (CPAP) therapy on IMA in patients with OSA.
Relevant studies were identified by searching PubMed and other databases in addition to manual searching of cross-references. Using random-effects model, the standardized mean differences (SMDs), pooled correlation coefficients and summary of diagnostic test accuracies were obtained with 95% confidence intervals (CIs). The meta-regression, sub-group and sensitivity analyses were performed to explore heterogeneity. The presence of publication bias was tested using funnel plot analysis followed by Begg's and Egger's tests for statistical signidicance.
This meta-analysis finally included nine studies. When comparing with non-OSA controls, the OSA patients showed a significantly increased circulatory IMA levels (SMD = 1.15, p = 0.0001). And, this increase is even more pronounced in severe-OSA group as compared to mild-moderate OSA patients (SMD = 076, p = 0.0006). A decrease in post-CPAP treatment IMA was observed when compared with that of baseline values. Meta-analysis of correlations showed significant associations of IMA with polysomnographic parameters. The pooled diagnostic odds ratio and area under curve were 19.58 and 0.888 (Q* = 0.819), respectively. There was no evidence of publication bias for the association of IMA with OSA.
This meta-analysis suggests that OSA is associated with significantly increased IMA levels which may indicate OS, ischemia and subclinical cardiovascular risk. In the diagnostic test accuracy meta-analysis, IMA showed good accuracy for OSA detection. However, further studies are required to establish its clinical utility.
文献报道氧化应激（OS）和缺血修饰白蛋白（IMA）与阻塞性睡眠呼吸暂停（OSA）密切相关，但关于 IMA 的结果尚存在争议。我们进行了一项荟萃分析，以评估 IMA 与 OSA 的相关性，以及持续气道正压通气（CPAP）治疗对 OSA 患者 IMA 的影响。
通过搜索 PubMed 和其他数据库以及手动搜索交叉引用，确定相关研究。使用随机效应模型，获得标准化均数差（SMD）、合并相关系数和诊断测试准确性的汇总，并使用 95%置信区间（CI）。进行元回归、亚组和敏感性分析以探索异质性。使用漏斗图分析检测发表偏倚，然后使用 Begg 和 Egger 检验进行统计学显著性检验。
本荟萃分析最终纳入 9 项研究。与非 OSA 对照组相比，OSA 患者的循环 IMA 水平明显升高（SMD=1.15，p=0.0001）。与轻中度 OSA 患者相比，重度 OSA 患者的这种升高更为明显（SMD=0.76，p=0.0006）。与基线值相比，CPAP 治疗后 IMA 降低。相关性的荟萃分析显示 IMA 与多导睡眠图参数存在显著相关性。合并的诊断优势比和曲线下面积分别为 19.58 和 0.888（Q*=0.819）。IMA 与 OSA 的相关性不存在发表偏倚的证据。
本荟萃分析表明，OSA 与 IMA 水平显著升高相关，这可能表明存在氧化应激、缺血和亚临床心血管风险。在诊断测试准确性的荟萃分析中，IMA 对 OSA 的检测具有良好的准确性。然而，需要进一步的研究来确定其临床应用价值。
