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Patients with Obstructive Sleep Apnea Display Increased Carotid Intima Media: A Meta-Analysis

DOI: 10.1155/2013/839582

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Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from ?0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, ( ). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process. 1. Introduction Obstructive sleep apnea (OSA), a common disorder, is often asymptomatic, and the prevalence of patients with OSA, who do not present clinical syndrome, might be as high as 20–30% in the middle-aged population [1]. OSA is a significant source of morbidity and mortality [2]. OSA is characterized by recurrent episodes of upper airway collapses during sleep. These recurrent episodes of upper airway collapse usually are accompanied by oxyhemoglobin desaturation and terminated by brief arousals which result in marked sleep fragmentation and chronic excessive daytime sleepiness (EDS) [1, 3]. As a result, there are an increased expression of systemic inflammatory markers, a sustained activation of the sympathetic nervous system [4], and derangement in endothelial function [5]. Many of these physiologic and biochemical abnormalities are implicated in the pathogenesis of cardiovascular and cerebrovascular diseases. Carotid intima media thickness (CIMT) is a surrogate marker for atherosclerotic disease and a means to detect subclinical atherosclerosis [6]. CIMT as measured by B-mode ultrasound represents the combined thickness of the intimal and medial layers of the carotid artery. Despite its limitations,

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