Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
Am J Hypertens. 2022 Jun 16;35(6):543-550. doi: 10.1093/ajh/hpac006.
Whether obstructive sleep apnea (OSA) actually represents an independent risk factor for aortic dilation in the general population is unclear. We investigated this issue through a review and a meta-analysis of cardiac imaging studies that provided data on this vascular phenotype measured at the root or ascending tract level.
A computerized search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 30 November 2021. Studies were identified by using the following search terms: "aortic root," "ascending aorta," "vascular damage," "echocardiography," "computed tomography," "magnetic resonance imaging," "obstructive sleep apnea," "sleep disordered breathing."
Eleven studies including a total of 1,860 patients with OSA (without aortic aneurysms and connective tissue diseases) and 233 non-OSA controls were considered. Aortic diameter was significantly higher in patients with OSA than in non-OSA controls (standard means difference [SMD] = 0.73 ± 0.08, confidence interval [CI]: 0.57-0.88, P < 0.0001). This was also the case for patients with severe OSA as compared with their counterparts with mild OSA (SMD = 0.42 ± 0.07, CI: 0.28-0.56, P < 0.0001).
Our findings suggest an association between OSA and aortic enlargement and particularly in the severe OSA setting. However, this conclusion must be taken with caution in relation to 2 types of factors: (i) the paucity of available data, and (ii) the limits deriving from the methodological differences of the various studies. Larger prospective and carefully designed studies are needed to shed light on this relevant public health topic.
阻塞性睡眠呼吸暂停（OSA）是否确实是一般人群中主动脉扩张的独立危险因素尚不清楚。我们通过对提供在根部或升主动脉水平测量的这种血管表型数据的心脏成像研究进行回顾和荟萃分析来研究这个问题。
使用 Pub-Med、OVID、EMBASE 和 Cochrane 图书馆数据库，从成立到 2021 年 11 月 30 日进行了计算机检索。使用以下搜索词识别研究：“主动脉根部”、“升主动脉”、“血管损伤”、“超声心动图”、“计算机断层扫描”、“磁共振成像”、“阻塞性睡眠呼吸暂停”、“睡眠呼吸障碍”。
共纳入 11 项研究，共包括 1860 例 OSA 患者（无主动脉瘤和结缔组织疾病）和 233 例非 OSA 对照。与非 OSA 对照组相比，OSA 患者的主动脉直径明显更高（标准均数差值 [SMD] = 0.73 ± 0.08，置信区间 [CI]：0.57-0.88，P < 0.0001）。与轻度 OSA 患者相比，重度 OSA 患者也是如此（SMD = 0.42 ± 0.07，CI：0.28-0.56，P < 0.0001）。
我们的研究结果表明，OSA 与主动脉扩大之间存在关联，特别是在严重 OSA 情况下。然而，与 2 种因素相关，该结论必须谨慎对待：（i）可用数据的缺乏，（ii）各种研究方法差异导致的局限性。需要进行更大规模的前瞻性和精心设计的研究，以阐明这一与公共卫生相关的重要问题。
