Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
J Sleep Res. 2020 Aug;29(4):e13046. doi: 10.1111/jsr.13046. Epub 2020 Apr 15.
There 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, I = 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.
目前越来越多的证据表明阻塞性睡眠呼吸暂停（OSA）可导致微血管功能障碍。然而，OSA 是否与冠状动脉血流储备受损相关仍不清楚。因此，我们进行了这项系统评价和荟萃分析以总结现有证据。在系统评价中，我们检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science；符合选择标准的五项观察性研究被纳入本研究。从入选研究中提取数据，并使用随机效应模型进行荟萃分析。共有 829 名 OSA 患者和 507 名非 OSA 患者纳入并评估了冠状动脉血流储备（CFR），这是冠状动脉微血管功能障碍（CMD）的临床指标。所有研究均显示 OSA 与 CFR 降低显著相关。CFR 的汇总加权均数差值（WMD）为-0.78（95%置信区间 [CI] -1.25 至 -0.32，p＜0.001，I²=84.4%）。研究之间的呼吸暂停低通气指数（AHI）差异可解释异质性的 89%（系数=-0.05，95%CI -0.12 至 0.02，p=0.078），表明 CFR 与 OSA 的严重程度呈负相关。Egger 回归检验无统计学意义（p=0.49）。总之，有合理的生物学机制将 OSA 与 CMD 联系起来，并且本系统评价的大多数证据表明，OSA，尤其是严重的 OSA，与 CFR 降低相关。需要进一步的前瞻性研究来进一步阐明 OSA 在 CMD 发生和发展中的确切作用。
