Association between obstructive sleep apnea syndrome and carotid atherosclerotic disease: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Huanhuan ¹ , LIU Lin ² , WANG Minmin ³ ,  HAN Jiming ¹

1. Medical College of Yan 'an University, Yan'an 716000, P. R. China;
2. Department of Respiratory and Critical Care Medicine, the Second Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;
3. Department of Cardiology, Affiliated to Binzhou Medical College, Binzhou 133000, P. R. China;

Corresponding?author：

HAN Jiming, Email: yadxhjm@163.com

Keywords：

Sleep apnea; Obstructive; Carotid atherosclerosis; Carotid intima-media thickness; Systematic review

DOI：

10.7507/1672-2531.202109154

Video：

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Objective To systematically review the correlation between obstructive sleep apnea syndrome (OSAS) and the incidence of carotid atherosclerosis. Methods PubMed, EMbase, CNKI, WanFang Data, CBM, and VIP databases were electronically searched to collect studies on the correlation between OSAS and carotid atherosclerosis and carotid intima-media thickness (CIMT) from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 16.0 software and RevMan 5.3 software. Results A total of 32 studies, including 2 915 patients were included. The results of the meta-analysis showed a higher incidence of carotid atherosclerotic plaque in OSAS patients than in the control group (OR=5.56, 95%CI 0.27 to 8.38, P<0.000 01); subgroup analysis revealed that, compared with the control group, patients who were male (OR=5.38, 95%CI 2.79 to 10.38, P<0.000 01) or had mild-to-moderate OSAS (OR=3.9, 95%CI 1.66 to 9.15, P=0.002) or severe OSAS (OR=19.86, 95%CI 6.49 to 60.82, P<0.000 01) had a higher risk of carotid atherosclerosis. The CIMT of the OSAS group was significantly higher than that of the control group (SMD=1.24, 95%CI 0.97 to 1.51, P<0.000 01). There was a positive correlation between the apnea hypopnea index (AHI) and CIMT in OSAS patients (r=0.52, 95%CI 0.44 to 0.60, <0.000 1), and the CIMT increased with OSAS severity. Conclusion OSAS is associated with a high incidence of carotid atherosclerotic plaque that is highly correlated with CIMT, which increases with an increase in the AHI. These findings are required to be verified in prospective high-quality studies to overcome the limitations of quantity and quality of studies included in this systematic review.

Citation： WANG Huanhuan, LIU Lin, WANG Minmin, HAN Jiming. Association between obstructive sleep apnea syndrome and carotid atherosclerotic disease: a systematic review. Chinese Journal of Evidence-Based Medicine, 2022, 22(2): 160-167. doi: 10.7507/1672-2531.202109154 Copy

1.	Pan L, Xie X, Liu D, et al. Obstructive sleep apnoea and risks of all-cause mortality: preliminary evidence from prospective cohort studies. Sleep Breath, 2016, 20(1): 345-353.
2.	Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol, 2013, 177(9): 1006-1014.
3.	史曉彤, 王翔宇, 劉君瑜, 等. 阻塞性睡眠呼吸暫停低通氣綜合征與口腔疾病關系研究進展. 中國實用口腔科雜志, 2019, 12(11): 684-688.
4.	Wang X, Ouyang Y, Wang Z, et al. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol, 2013, 169(3): 207-214.
5.	黃衛, 鄧麗影. 阻塞性睡眠呼吸暫停低通氣綜合征與頸動脈粥樣硬化關系研究進展. 實用臨床醫學, 2007, 8(5): 134-135,138.
6.	Mancini GB, Dahlöf B, Díez J. Surrogate markers for cardiovascular disease: structural markers. Circulation, 2004, 109(25 Suppl 1): IV22-30.
7.	Lee S, Cho GY, Kim HS, et al. Common carotid intima-media thickness as a risk factor for outcomes in Asian patients with acute ST-elevation myocardial infarction. Can J Cardiol, 2014, 30(12): 1620-1626.
8.	張輝, 余舒杰, 毛永江, 等. 頸動脈內膜中層厚度測量和超聲回聲跟蹤技術檢測高脂蛋白(a)血癥家族成員頸動脈粥樣硬化程度研究. 中國全科醫學, 2015, 18(30): 3759-3762,3768.
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11.	Zureik M, Ducimetière P, Touboul PJ, et al. Common carotid intima-media thickness predicts occurrence of carotid atherosclerotic plaques: longitudinal results from the Aging Vascular Study (EVA) study. Arterioscler Thromb Vasc Biol, 2000, 20(6): 1622-1629.
12.	羅杰, 冷衛東. 系統評價/Meta分析理論與實踐. 中國循證心血管醫學雜志, 2013, 5(2): 115.
13.	Kaynak D, G?ksan B, Kaynak H, et al. Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries. Eur J Neurol, 2003, 10(5): 487-493.
14.	Liao LJ, Huang TW. Assessment of carotid artery intima-media thickness in patients with obstructive sleep apnea. Ultrasound in Medicine and Biology, 2017, 43: S181.
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20.	Azar C, Abakay ?, Azar ?, et al. The relationship between the heart-type fatty acid binding protein levels, carotid intima media thickness and epicardial fat thickness in patients with obstructive sleep apnea syndrome. Tuberk Toraks, 2020, 68(1): 1-8.
21.	Chang YT, Lin HC, Chang WN, et al. Impact of inflammation and oxidative stress on carotid intima-media thickness in obstructive sleep apnea patients without metabolic syndrome. J Sleep Res, 2017, 26(2): 151-158.
22.	Ciccone MM, Scicchitano P, Zito A, et al. Correlation between inflammatory markers of atherosclerosis and carotid intima-media thickness in obstructive sleep apnea. Molecules, 2014, 19(2): 1651-1662.
23.	Farooqui FA, Sharma SK, Kumar A, et al. Endothelial function and carotid intima media thickness in obstructive sleep apnea without comorbidity. Sleep Breath, 2017, 21(1): 69-76.
24.	Gunbatar H, Sertogullarindan B, Ekin S, et al. The correlation between red blood cell distribution width levels with the severity of obstructive sleep apnea and carotid intima media thickness. Med Sci Monit, 2014, 20: 2199-2204.
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27.	Silvestrini M, Rizzato B, Placidi F, et al. Carotid artery wall thickness in patients with obstructive sleep apnea syndrome. Stroke, 2002, 33(7): 1782-1785.
28.	Tan TY, Liou CW, Friedman M, et al. Factors associated with increased carotid intima-media thickness in obstructive sleep apnea/hypopnea syndrome. Neurologist, 2012, 18(5): 277-281.
29.	Tanriverdi H, Evrengul H, Kara CO, et al. Aortic stiffness, flow-mediated dilatation and carotid intima-media thickness in obstructive sleep apnea: non-invasive indicators of atherosclerosis. Respiration, 2006, 73(6): 741-750.
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33.	蘭世才. 阻塞性睡眠呼吸暫停綜合征合并高血壓患者頸動脈內皮功能和血清C-反應蛋白水平變化的意義. 四川醫學, 2012, 33(7): 1256-1258.
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35.	么太成, 王賀龍, 高文靜, 等. 頸動脈內膜中層厚度和阻塞性睡眠呼吸暫停低通氣綜合征相關性研究. 中國綜合臨床, 2009, 25(3): 280-282.
36.	宋凡. OSAS患者頸動脈內膜中層厚度和動脈彈性與脂肪細胞因子之間的關系. 上海: 上海交通大學, 2019.
37.	許輝, 曹非, 魏桂榮, 等. 阻塞性睡眠呼吸暫停低通氣綜合征患者病情與血尿酸水平及頸動脈粥樣硬化的關系. 臨床神經病學雜志, 2010, 23(6): 411-413.
38.	閆曉娟, 趙欣, 饒遠生, 等. OSAS患者血清脂多糖結合蛋白和頸動脈粥樣硬化的相關性分析. 中國耳鼻咽喉顱底外科雜志, 2018, 24(5): 401-404,416.
39.	陽書坤, 霍開秀, 徐福琴, 等. 阻塞性睡眠呼吸暫停低通氣綜合征患者血漿內脂素水平與頸動脈內膜中層厚度的關系. 臨床內科雜志, 2013, 30(6): 401-404.
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41.	張立建, 鐘惠娟, 謝富蘭, 等. OSAS合并原發性高血壓患者血漿內皮素-1與頸動脈內膜中層厚度的變化. 熱帶醫學雜志, 2009, 9(8): 879-881.
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1. Pan L, Xie X, Liu D, et al. Obstructive sleep apnoea and risks of all-cause mortality: preliminary evidence from prospective cohort studies. Sleep Breath, 2016, 20(1): 345-353.
2. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol, 2013, 177(9): 1006-1014.
3. 史曉彤, 王翔宇, 劉君瑜, 等. 阻塞性睡眠呼吸暫停低通氣綜合征與口腔疾病關系研究進展. 中國實用口腔科雜志, 2019, 12(11): 684-688.
4. Wang X, Ouyang Y, Wang Z, et al. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol, 2013, 169(3): 207-214.
5. 黃衛, 鄧麗影. 阻塞性睡眠呼吸暫停低通氣綜合征與頸動脈粥樣硬化關系研究進展. 實用臨床醫學, 2007, 8(5): 134-135,138.
6. Mancini GB, Dahlöf B, Díez J. Surrogate markers for cardiovascular disease: structural markers. Circulation, 2004, 109(25 Suppl 1): IV22-30.
7. Lee S, Cho GY, Kim HS, et al. Common carotid intima-media thickness as a risk factor for outcomes in Asian patients with acute ST-elevation myocardial infarction. Can J Cardiol, 2014, 30(12): 1620-1626.
8. 張輝, 余舒杰, 毛永江, 等. 頸動脈內膜中層厚度測量和超聲回聲跟蹤技術檢測高脂蛋白(a)血癥家族成員頸動脈粥樣硬化程度研究. 中國全科醫學, 2015, 18(30): 3759-3762,3768.
9. 曹亞英, 孫可欣, 項驍, 等. 2型糖尿病患者血糖控制與頸動脈內膜中層厚度的相關性研究. 中華疾病控制雜志, 2016, 20(7): 647-651.
10. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med, 2012, 8(5): 597-619.
11. Zureik M, Ducimetière P, Touboul PJ, et al. Common carotid intima-media thickness predicts occurrence of carotid atherosclerotic plaques: longitudinal results from the Aging Vascular Study (EVA) study. Arterioscler Thromb Vasc Biol, 2000, 20(6): 1622-1629.
12. 羅杰, 冷衛東. 系統評價/Meta分析理論與實踐. 中國循證心血管醫學雜志, 2013, 5(2): 115.
13. Kaynak D, G?ksan B, Kaynak H, et al. Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries. Eur J Neurol, 2003, 10(5): 487-493.
14. Liao LJ, Huang TW. Assessment of carotid artery intima-media thickness in patients with obstructive sleep apnea. Ultrasound in Medicine and Biology, 2017, 43: S181.
15. Minoguchi K, Yokoe T, Tazaki T, et al. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med, 2005, 172(5): 625-630.
16. Ozdemir C, Conkbay?r I, Kuru A, et al. Correlation between the intima-media thickness and Framingham risk score in patients with sleep apnea syndrome. J Thorac Dis, 2013, 5(6): 751-757.
17. 程穗茗, 陳軍初, 劉世明, 等. OSAS合并心血管病患者血管內皮功能及頸動脈內膜中層厚度的變化. 廣東醫學, 2008, 29(6): 972-974.
18. 滕菲, 郭燕, 李英梅, 等. 阻塞性睡眠呼吸暫停低通氣綜合征患者頸動脈內中膜厚度研究. 當代醫學, 2020, 26(7): 34-36.
19. Akyuz A, Oran M, Alpsoy S, et al. Association between serum fetuin-A levels, carotid artery stiffness, and intima-media thickness in patients with normotensive obstructive sleep apnea syndrome. Angiology, 2014, 65(7): 607-613.
20. Azar C, Abakay ?, Azar ?, et al. The relationship between the heart-type fatty acid binding protein levels, carotid intima media thickness and epicardial fat thickness in patients with obstructive sleep apnea syndrome. Tuberk Toraks, 2020, 68(1): 1-8.
21. Chang YT, Lin HC, Chang WN, et al. Impact of inflammation and oxidative stress on carotid intima-media thickness in obstructive sleep apnea patients without metabolic syndrome. J Sleep Res, 2017, 26(2): 151-158.
22. Ciccone MM, Scicchitano P, Zito A, et al. Correlation between inflammatory markers of atherosclerosis and carotid intima-media thickness in obstructive sleep apnea. Molecules, 2014, 19(2): 1651-1662.
23. Farooqui FA, Sharma SK, Kumar A, et al. Endothelial function and carotid intima media thickness in obstructive sleep apnea without comorbidity. Sleep Breath, 2017, 21(1): 69-76.
24. Gunbatar H, Sertogullarindan B, Ekin S, et al. The correlation between red blood cell distribution width levels with the severity of obstructive sleep apnea and carotid intima media thickness. Med Sci Monit, 2014, 20: 2199-2204.
25. Karamanli H, Kiyici A, Arik B, et al. Influence of obstructive sleep apnea on ischemia-modified albumin levels and carotid intima-media thickness. J Investig Med, 2016, 64(5): 1035-1041.
26. Sarioglu N, Demirpolat G, Erel F, et al. Which is the ideal marker for early atherosclerosis in obstructive sleep apnea (OSA) - carotid intima-media thickness or mean platelet volume. Med Sci Monit, 2017, 23: 1674-1681.
27. Silvestrini M, Rizzato B, Placidi F, et al. Carotid artery wall thickness in patients with obstructive sleep apnea syndrome. Stroke, 2002, 33(7): 1782-1785.
28. Tan TY, Liou CW, Friedman M, et al. Factors associated with increased carotid intima-media thickness in obstructive sleep apnea/hypopnea syndrome. Neurologist, 2012, 18(5): 277-281.
29. Tanriverdi H, Evrengul H, Kara CO, et al. Aortic stiffness, flow-mediated dilatation and carotid intima-media thickness in obstructive sleep apnea: non-invasive indicators of atherosclerosis. Respiration, 2006, 73(6): 741-750.
30. Yun CH, Jung KH, Chu K, et al. Increased circulating endothelial microparticles and carotid atherosclerosis in obstructive sleep apnea. J Clin Neurol, 2010, 6(2): 89-98.
31. 章哪哪, 李艷妮, 李本農, 等. 外周血Th17細胞與OSA患者頸動脈內-中膜厚度的相關性. 臨床耳鼻咽喉頭頸外科雜志, 2020, 34(8): 747-751.
32. 陳碧, 張文輝陳玉玲, 等. 阻塞性睡眠呼吸暫停低通氣綜合征與頸動脈粥樣硬化的相關性及持續氣道正壓通氣治療的作用. 中華醫學雜志, 2015, 95(34): 2791-2795.
33. 蘭世才. 阻塞性睡眠呼吸暫停綜合征合并高血壓患者頸動脈內皮功能和血清C-反應蛋白水平變化的意義. 四川醫學, 2012, 33(7): 1256-1258.
34. 劉會苗, 楊青, 張展, 等. 阻塞型睡眠呼吸暫停低通氣綜合征對頸動脈硬化的影響. 河南醫學研究, 2020, 29(3): 397-399.
35. 么太成, 王賀龍, 高文靜, 等. 頸動脈內膜中層厚度和阻塞性睡眠呼吸暫停低通氣綜合征相關性研究. 中國綜合臨床, 2009, 25(3): 280-282.
36. 宋凡. OSAS患者頸動脈內膜中層厚度和動脈彈性與脂肪細胞因子之間的關系. 上海: 上海交通大學, 2019.
37. 許輝, 曹非, 魏桂榮, 等. 阻塞性睡眠呼吸暫停低通氣綜合征患者病情與血尿酸水平及頸動脈粥樣硬化的關系. 臨床神經病學雜志, 2010, 23(6): 411-413.
38. 閆曉娟, 趙欣, 饒遠生, 等. OSAS患者血清脂多糖結合蛋白和頸動脈粥樣硬化的相關性分析. 中國耳鼻咽喉顱底外科雜志, 2018, 24(5): 401-404,416.
39. 陽書坤, 霍開秀, 徐福琴, 等. 阻塞性睡眠呼吸暫停低通氣綜合征患者血漿內脂素水平與頸動脈內膜中層厚度的關系. 臨床內科雜志, 2013, 30(6): 401-404.
40. 余坤城, 謝江霞, 陽書坤, 等. 阻塞性睡眠呼吸暫停綜合征患者血栓形成前狀態分子與頸動脈內膜中層厚度的關系. 內科急危重癥雜志, 2015, 21(4): 279-281.
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Chinese Journal of Evidence-Based Medicine

Association between obstructive sleep apnea syndrome and carotid atherosclerotic disease: a systematic review

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