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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.


A – Forest plot summarizing the association between ODI and MS in the 3 included studies under the random effects meta-analysis. B – Forest plot summarizing the association between CT90 and MS in the 3 included studies under the fixed effects meta-analysis
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Figure 0005: A – Forest plot summarizing the association between ODI and MS in the 3 included studies under the random effects meta-analysis. B – Forest plot summarizing the association between CT90 and MS in the 3 included studies under the fixed effects meta-analysis

Mentions: ODI and CT90, two nocturnal IH-measuring indexes that were available in the original studies, were also found to be associated with increased MS risk. The pooled OR for MS in individuals with higher ODI was 1.96 (95% CI: 1.30–2.96, p < 0.001), with evidence of high heterogeneity (I2 = 90.5%, p < 0.001) (Figure 5 A). The heterogeneity could not be explained by meta regression of any confounding factors including mean age, sex ratio, mean BMI, geographic region, ODI category, MS criteria, study design, and method of diagnosis of ODI. The pooled OR for MS in individuals with higher CT90 was 1.05 (95% CI: 1.02–1.07, p < 0.001), with no evidence of variation (I2 = 0%, p = 0.612) (Figure 5 B). Egger's test confirmed that there was no significant publication bias (p = 0.392/0.967 separately). When adjusted for BMI, both the associations between ODI and MS (pooled OR = 1.33, 95% CI: 1.06–1.67, p = 0.01) and between CT90 and MS (pooled OR = 1.05, 95% CI: 1.02–1.07, p < 0.001) remained significant.


Obstructive sleep apnea predicts risk of metabolic syndrome independently of obesity: a meta-analysis
A – Forest plot summarizing the association between ODI and MS in the 3 included studies under the random effects meta-analysis. B – Forest plot summarizing the association between CT90 and MS in the 3 included studies under the fixed effects meta-analysis
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5016589&req=5

Figure 0005: A – Forest plot summarizing the association between ODI and MS in the 3 included studies under the random effects meta-analysis. B – Forest plot summarizing the association between CT90 and MS in the 3 included studies under the fixed effects meta-analysis
Mentions: ODI and CT90, two nocturnal IH-measuring indexes that were available in the original studies, were also found to be associated with increased MS risk. The pooled OR for MS in individuals with higher ODI was 1.96 (95% CI: 1.30–2.96, p < 0.001), with evidence of high heterogeneity (I2 = 90.5%, p < 0.001) (Figure 5 A). The heterogeneity could not be explained by meta regression of any confounding factors including mean age, sex ratio, mean BMI, geographic region, ODI category, MS criteria, study design, and method of diagnosis of ODI. The pooled OR for MS in individuals with higher CT90 was 1.05 (95% CI: 1.02–1.07, p < 0.001), with no evidence of variation (I2 = 0%, p = 0.612) (Figure 5 B). Egger's test confirmed that there was no significant publication bias (p = 0.392/0.967 separately). When adjusted for BMI, both the associations between ODI and MS (pooled OR = 1.33, 95% CI: 1.06–1.67, p = 0.01) and between CT90 and MS (pooled OR = 1.05, 95% CI: 1.02–1.07, p < 0.001) remained significant.

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.