Evaluation of Circulating Levels of ICAM-1 in Obstructive Sleep Apnea (OSA) Adults: Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Link Between OSA and Cardiovascular Disease.

Obstructive sleep apnea (OSA) is a common condition characterized by repeated airway collapses during sleep, contributing to oxygen desaturation, arousals, and significant cardiovascular complications. This meta-analysis aims to evaluate the association between blood ICAM-1 levels and OSA, exploring its potential as a biomarker for cardiovascular disease (CVD) and for identifying factors contributing to result heterogeneity. Following PRISMA guidelines, this meta-analysis addressed a PECO framework to assess circulating ICAM-1 levels in adults with OSA compared to controls. A systematic search was conducted across PubMed, Web of Science, Scopus, Cochrane Library, and CNKI until 23 April 2025, complemented by citation reviews and Google Scholar. Statistical analyses, including subgroup and meta-regression, were performed using RevMan, CMA 3.0, and TSA software to calculate mean differences, assess heterogeneity, and evaluate publication bias. Results were analyzed under random-effect models, with significance set at < 0.05 for all metrics except publication bias ( < 0.10). This systematic review and meta-analysis included 34 articles. The pooled mean difference (MD) of ICAM-1 levels was 184.06 ng/mL (95% CI: 143.83 to 224.28; < 0.00001), significantly higher in OSA patients with high heterogeneity (I = 100%). Subgroup analysis highlighted larger MDs in Asians and plasma samples, as well as greater ICAM-1 elevations in severe OSA cases. Despite publication bias indicated by Begg's ( = 0.036) and Egger's ( = 0.016) tests, the findings remained robust, supported by sensitivity and meta-regression analyses. This meta-analysis underscores a significant association between elevated ICAM-1 levels and OSA, highlighting its potential as a biomarker for CVD risk stratification in OSA patients.