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.	史晓彤, 王翔宇, 刘君瑜, 等. 阻塞性睡眠呼吸暂停低通气综合征与口腔疾病关系研究进展. 中国实用口腔科杂志, 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.	黄卫, 邓丽影. 阻塞性睡眠呼吸暂停低通气综合征与颈动脉粥样硬化关系研究进展. 实用临床医学, 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.	张辉, 余舒杰, 毛永江, 等. 颈动脉内膜中层厚度测量和超声回声跟踪技术检测高脂蛋白(a)血症家族成员颈动脉粥样硬化程度研究. 中国全科医学, 2015, 18(30): 3759-3762,3768.
9.	曹亚英, 孙可欣, 项骁, 等. 2型糖尿病患者血糖控制与颈动脉内膜中层厚度的相关性研究. 中华疾病控制杂志, 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.	罗杰, 冷卫东. 系统评价/Meta分析理论与实践. 中国循证心血管医学杂志, 2013, 5(2): 115.
13.	Kaynak D, Göksan 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, Conkbayır 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, 陈军初, 刘世明, 等. OSAS合并心血管病患者血管内皮功能及颈动脉内膜中层厚度的变化. 广东医学, 2008, 29(6): 972-974.
18.	滕菲, 郭燕, 李英梅, 等. 阻塞性睡眠呼吸暂停低通气综合征患者颈动脉内中膜厚度研究. 当代医学, 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 Ö, Azar Ş, 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, 李艳妮, 李本农, 等. 外周血Th17细胞与OSA患者颈动脉内-中膜厚度的相关性. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 747-751.
32.	陈碧, 张文辉陈玉玲, 等. 阻塞性睡眠呼吸暂停低通气综合征与颈动脉粥样硬化的相关性及持续气道正压通气治疗的作用. 中华医学杂志, 2015, 95(34): 2791-2795.
33.	兰世才. 阻塞性睡眠呼吸暂停综合征合并高血压患者颈动脉内皮功能和血清C-反应蛋白水平变化的意义. 四川医学, 2012, 33(7): 1256-1258.
34.	刘会苗, 杨青, 张展, 等. 阻塞型睡眠呼吸暂停低通气综合征对颈动脉硬化的影响. 河南医学研究, 2020, 29(3): 397-399.
35.	么太成, 王贺龙, 高文静, 等. 颈动脉内膜中层厚度和阻塞性睡眠呼吸暂停低通气综合征相关性研究. 中国综合临床, 2009, 25(3): 280-282.
36.	宋凡. OSAS患者颈动脉内膜中层厚度和动脉弹性与脂肪细胞因子之间的关系. 上海: 上海交通大学, 2019.
37.	许辉, 曹非, 魏桂荣, 等. 阻塞性睡眠呼吸暂停低通气综合征患者病情与血尿酸水平及颈动脉粥样硬化的关系. 临床神经病学杂志, 2010, 23(6): 411-413.
38.	闫晓娟, 赵欣, 饶远生, 等. OSAS患者血清脂多糖结合蛋白和颈动脉粥样硬化的相关性分析. 中国耳鼻咽喉颅底外科杂志, 2018, 24(5): 401-404,416.
39.	阳书坤, 霍开秀, 徐福琴, 等. 阻塞性睡眠呼吸暂停低通气综合征患者血浆内脂素水平与颈动脉内膜中层厚度的关系. 临床内科杂志, 2013, 30(6): 401-404.
40.	余坤城, 谢江霞, 阳书坤, 等. 阻塞性睡眠呼吸暂停综合征患者血栓形成前状态分子与颈动脉内膜中层厚度的关系. 内科急危重症杂志, 2015, 21(4): 279-281.
41.	张立建, 钟惠娟, 谢富兰, 等. OSAS合并原发性高血压患者血浆内皮素-1与颈动脉内膜中层厚度的变化. 热带医学杂志, 2009, 9(8): 879-881.
42.	张宗辉, 郑良荣, 傅颖, 等. 颈动脉内膜中层厚度与中青年阻塞性睡眠呼吸暂停低通气综合征关系. 心脑血管病防治, 2008, 8(2): 79-80.
43.	朱宏霞, 王镇山, 薛欣, 等. 阻塞型睡眠呼吸暂停低通气综合征与颈动脉硬化、胰岛素抵抗的相关性研究. 大连医科大学学报, 2012, 34(3): 248-251,261.
44.	邹慧, 敖强国, 张丽萍, 等. 老年阻塞性睡眠呼吸暂停患者的颈动脉内膜中层厚度. 中华老年多器官疾病杂志, 2011, 10(2): 110-112.
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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. 史晓彤, 王翔宇, 刘君瑜, 等. 阻塞性睡眠呼吸暂停低通气综合征与口腔疾病关系研究进展. 中国实用口腔科杂志, 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. 黄卫, 邓丽影. 阻塞性睡眠呼吸暂停低通气综合征与颈动脉粥样硬化关系研究进展. 实用临床医学, 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. 张辉, 余舒杰, 毛永江, 等. 颈动脉内膜中层厚度测量和超声回声跟踪技术检测高脂蛋白(a)血症家族成员颈动脉粥样硬化程度研究. 中国全科医学, 2015, 18(30): 3759-3762,3768.
9. 曹亚英, 孙可欣, 项骁, 等. 2型糖尿病患者血糖控制与颈动脉内膜中层厚度的相关性研究. 中华疾病控制杂志, 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. 罗杰, 冷卫东. 系统评价/Meta分析理论与实践. 中国循证心血管医学杂志, 2013, 5(2): 115.
13. Kaynak D, Göksan 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, Conkbayır 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, 陈军初, 刘世明, 等. OSAS合并心血管病患者血管内皮功能及颈动脉内膜中层厚度的变化. 广东医学, 2008, 29(6): 972-974.
18. 滕菲, 郭燕, 李英梅, 等. 阻塞性睡眠呼吸暂停低通气综合征患者颈动脉内中膜厚度研究. 当代医学, 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 Ö, Azar Ş, 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, 李艳妮, 李本农, 等. 外周血Th17细胞与OSA患者颈动脉内-中膜厚度的相关性. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 747-751.
32. 陈碧, 张文辉陈玉玲, 等. 阻塞性睡眠呼吸暂停低通气综合征与颈动脉粥样硬化的相关性及持续气道正压通气治疗的作用. 中华医学杂志, 2015, 95(34): 2791-2795.
33. 兰世才. 阻塞性睡眠呼吸暂停综合征合并高血压患者颈动脉内皮功能和血清C-反应蛋白水平变化的意义. 四川医学, 2012, 33(7): 1256-1258.
34. 刘会苗, 杨青, 张展, 等. 阻塞型睡眠呼吸暂停低通气综合征对颈动脉硬化的影响. 河南医学研究, 2020, 29(3): 397-399.
35. 么太成, 王贺龙, 高文静, 等. 颈动脉内膜中层厚度和阻塞性睡眠呼吸暂停低通气综合征相关性研究. 中国综合临床, 2009, 25(3): 280-282.
36. 宋凡. OSAS患者颈动脉内膜中层厚度和动脉弹性与脂肪细胞因子之间的关系. 上海: 上海交通大学, 2019.
37. 许辉, 曹非, 魏桂荣, 等. 阻塞性睡眠呼吸暂停低通气综合征患者病情与血尿酸水平及颈动脉粥样硬化的关系. 临床神经病学杂志, 2010, 23(6): 411-413.
38. 闫晓娟, 赵欣, 饶远生, 等. OSAS患者血清脂多糖结合蛋白和颈动脉粥样硬化的相关性分析. 中国耳鼻咽喉颅底外科杂志, 2018, 24(5): 401-404,416.
39. 阳书坤, 霍开秀, 徐福琴, 等. 阻塞性睡眠呼吸暂停低通气综合征患者血浆内脂素水平与颈动脉内膜中层厚度的关系. 临床内科杂志, 2013, 30(6): 401-404.
40. 余坤城, 谢江霞, 阳书坤, 等. 阻塞性睡眠呼吸暂停综合征患者血栓形成前状态分子与颈动脉内膜中层厚度的关系. 内科急危重症杂志, 2015, 21(4): 279-281.
41. 张立建, 钟惠娟, 谢富兰, 等. OSAS合并原发性高血压患者血浆内皮素-1与颈动脉内膜中层厚度的变化. 热带医学杂志, 2009, 9(8): 879-881.
42. 张宗辉, 郑良荣, 傅颖, 等. 颈动脉内膜中层厚度与中青年阻塞性睡眠呼吸暂停低通气综合征关系. 心脑血管病防治, 2008, 8(2): 79-80.
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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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