Prevalence of coronary atherosclerosis in patients with obstructive sleep apnea syndrome: a systematic review and meta-analysis.

BACKGROUND

Obstructive sleep apnea (OSA) syndrome is a common sleep-related breathing disorder characterized by recurrent episodes of upper airway collapse during sleep. Coronary atherosclerosis, a significant cause of cardiovascular morbidity and mortality worldwide, has been associated with OSA in several studies. However, the precise nature and magnitude of this association remain incompletely defined. This study sought to systematically evaluate the available evidence and quantify the relationship between OSA and coronary atherosclerosis through meta-analysis. METHOD: A systematic literature review across PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception through September 3, 2024. Two investigators performed independent literature screening, data extraction, and quality assessment of included studies. Statistical assessment was performed using Stata 18.

RESULTS

Analysis of 11 studies encompassing 6587 participants revealed that the overall prevalence of coronary atherosclerosis within the OSA patients was 46% (95% CI: 32%-60%; I2 = 98.5%; P < 0.001). Subgroup analysis demonstrated that coronary atherosclerosis prevalence increased proportionally with OSA severity: 33% (95% CI: 9%-57%; I2 = 99.2%; P < 0.001) in mild OSA, 58% (95% CI: 47%-70%; I2 = 68.4%; P = 0.024) in moderate OSA, and 68% (95% CI: 61%-76%; I2 = 57.2%; P = 0.053) in severe OSA, with an overall prevalence across all severity categories of 50% (95% CI: 34%-66%; P < 0.001).

CONCLUSION

The analysis demonstrates that OSA is associated with an elevated risk of coronary atherosclerosis, with prevalence increasing in parallel with disease severity, it was only demonstrated in observational studies, but not in RCTs.