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Obstructive sleep apnea predicts risk of metabolic syndrome independently of obesity: a meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Obstructive sleep apnea (OSA) has been suggested to be associated with a high risk of metabolic syndrome (MS). However, results on whether the association between OSA and risk of MS is independent of obesity, and the effect of nocturnal intermittent hypoxia (IH) on MS, are conflicting. Our purpose was to estimate the magnitude of the independent association between OSA and risk of MS and further explore whether nocturnal IH in OSA plays a role in MS risk.

Material and methods: The PubMed and EMBASE databases were systematically searched (until January 21, 2015) for available observational evidence. Unadjusted and body mass index (BMI)-adjusted pooled odds ratios (ORs) for MS in OSA or higher nocturnal IH were calculated using fixed or random models. Tests of homogeneity, publication bias, and robustness of the results were performed.

Results: A total of 13 independent studies (involving 857 participants in 3 case-control studies and 7077 participants in 10 cross-sectional studies) were included. The OSA was significantly associated with an increased risk of MS in a meta-analysis of 10 studies (pooled OR = 1.72, 95% CI: 1.31–2.26, p < 0.001), with a BMI-adjusted pooled OR of 1.97 (95% CI: 1.34–2.88, p < 0.001). Pooled results from 3 studies on the oxygen desaturation index (ODI) and MS risk (OR = 1.96, 95% CI: 1.73–2.22, p < 0.001) and 3 studies on the cumulative percentage of sleep time with SpO2 below 90% (CT90) and MS risk (OR = 1.05, 95% CI: 1.02–1.07, p < 0.001) were also significant.

Conclusions: Our findings demonstrated a significant association between OSA and increased MS risk independent of BMI, and further indicated a role of nocturnal IH in this association.

No MeSH data available.


Forest plot summarizing the subgroup meta-analysis of the association between OSA and MS by OSA criteria (binary and continuous)
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Figure 0003: Forest plot summarizing the subgroup meta-analysis of the association between OSA and MS by OSA criteria (binary and continuous)

Mentions: To explore the source of heterogeneity, independent variables including mean age, sex ratio, mean BMI, geographic region (“Europe”, “America”, and “Asia”), OSA category (“binary”, “continuous”), MS criteria (“NCEP ATPIII”, “IDF”, and “Japanese criteria”), and study design (“case control”, “cross sectional”) were introduced into the univariate meta regression analysis. Among these, only the OSA category was significantly related to high heterogeneity (p = 0.018). Therefore, we presented the final results by subgroup analysis with reference to OSA category. The combined ORs between OSA and MS risk in binary and continuous categorized studies were 2.47 (95% CI: 1.61–3.77, p < 0.001) and 1.14 (95% CI: 0.98–1.34, p = 0.10), respectively (Figure 3). The heterogeneity in the two subgroups decreased but could not be fully explained by the OSA category (I2 = 57%, p = 0.03 in the binary group and I2 = 63.3%, p = 0.066 in the continuous group).


Obstructive sleep apnea predicts risk of metabolic syndrome independently of obesity: a meta-analysis
Forest plot summarizing the subgroup meta-analysis of the association between OSA and MS by OSA criteria (binary and continuous)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016589&req=5

Figure 0003: Forest plot summarizing the subgroup meta-analysis of the association between OSA and MS by OSA criteria (binary and continuous)
Mentions: To explore the source of heterogeneity, independent variables including mean age, sex ratio, mean BMI, geographic region (“Europe”, “America”, and “Asia”), OSA category (“binary”, “continuous”), MS criteria (“NCEP ATPIII”, “IDF”, and “Japanese criteria”), and study design (“case control”, “cross sectional”) were introduced into the univariate meta regression analysis. Among these, only the OSA category was significantly related to high heterogeneity (p = 0.018). Therefore, we presented the final results by subgroup analysis with reference to OSA category. The combined ORs between OSA and MS risk in binary and continuous categorized studies were 2.47 (95% CI: 1.61–3.77, p < 0.001) and 1.14 (95% CI: 0.98–1.34, p = 0.10), respectively (Figure 3). The heterogeneity in the two subgroups decreased but could not be fully explained by the OSA category (I2 = 57%, p = 0.03 in the binary group and I2 = 63.3%, p = 0.066 in the continuous group).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Obstructive sleep apnea (OSA) has been suggested to be associated with a high risk of metabolic syndrome (MS). However, results on whether the association between OSA and risk of MS is independent of obesity, and the effect of nocturnal intermittent hypoxia (IH) on MS, are conflicting. Our purpose was to estimate the magnitude of the independent association between OSA and risk of MS and further explore whether nocturnal IH in OSA plays a role in MS risk.

Material and methods: The PubMed and EMBASE databases were systematically searched (until January 21, 2015) for available observational evidence. Unadjusted and body mass index (BMI)-adjusted pooled odds ratios (ORs) for MS in OSA or higher nocturnal IH were calculated using fixed or random models. Tests of homogeneity, publication bias, and robustness of the results were performed.

Results: A total of 13 independent studies (involving 857 participants in 3 case-control studies and 7077 participants in 10 cross-sectional studies) were included. The OSA was significantly associated with an increased risk of MS in a meta-analysis of 10 studies (pooled OR = 1.72, 95% CI: 1.31&ndash;2.26, p &lt; 0.001), with a BMI-adjusted pooled OR of 1.97 (95% CI: 1.34&ndash;2.88, p &lt; 0.001). Pooled results from 3 studies on the oxygen desaturation index (ODI) and MS risk (OR = 1.96, 95% CI: 1.73&ndash;2.22, p &lt; 0.001) and 3 studies on the cumulative percentage of sleep time with SpO2 below 90% (CT90) and MS risk (OR = 1.05, 95% CI: 1.02&ndash;1.07, p &lt; 0.001) were also significant.

Conclusions: Our findings demonstrated a significant association between OSA and increased MS risk independent of BMI, and further indicated a role of nocturnal IH in this association.

No MeSH data available.