阻塞性睡眠呼吸暂停综合征与颈动脉粥样硬化相关性的系统评价

目的系统评价阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)与颈动脉粥样硬化疾病的相关性。方法计算机检索PubMed、EMbase、CNKI、WanFang Data、CBM和VIP数据库,搜集OSAS与颈动脉粥样硬化疾病和颈动脉内膜中层厚度(carotid intima–media thickness,CIMT)相关性的研究,检索时限均从建库至2021年8月10日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Stata 16.0软件进行Meta分析。结果共纳入32个研究,包括2915例患者。Meta分析结果显示:与对照组相比,OSAS患者颈动脉粥样硬化斑块发生率更高OR=5.56,95%CI(0.27,8.38),P<0.00001]。亚组分析结果发现,男性OR=5.38,95%CI(2.79,10.38),P<0.00001]、轻中度OSASOR=3.9,95%CI(1.66,9.15),P=0.002]、重度OSASOR=19.86,95%CI(6.49,60.82),P<0.00001]患者颈动脉粥样硬化斑块发生风险均高;此外,OSAS组与对照组相比CIMT明显升高SMD=1.24,95%CI(0.97,1.51),P<0.00001]。OSAS患者AHI和CIMT间呈正相关r=0.52,95%CI(0.44,0.60),P<0.0001],CIMT随OSAS严重程度的增加而升高。结论OSAS患者颈动脉粥样硬化斑块发生率更高,与CIMT呈正相关,且CIMT会随AHI的升高而升高。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

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

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 2915 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<0.00001);subgroup analysis revealed that,compared with the control group,patients who were male(OR=5.38,95%CI 2.79 to 10.38,P<0.00001)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<0.00001)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<0.00001).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,<0.0001),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.