A systematic review, meta-analysis, and trial sequential analysis on association of circulating vascular cell adhesion molecule-1 (VCAM-1) levels in obstructive sleep apnea adults: A possible link between cardiovascular disease and obstructive sleep apnea.

BACKGROUND AND

OBJECTIVES

Obstructive sleep apnea (OSA), marked by recurrent upper airway obstruction during sleep, poses significant risks due to its association with cardiovascular diseases. This study systematically analyzed the link between circulating vascular cell adhesion molecule-1 (VCAM-1) levels and OSA, highlighting its role as a biomarker of endothelial dysfunction and its potential connection to cardiovascular disease.

MATERIAL AND

METHODS

The databases searched for the meta-analysis included PubMed/Medline, Scopus, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI), up to March 22, 2025. Effect sizes were calculated using the standard mean difference (SMD) with 95% confidence intervals (CIs), and advanced statistical techniques such as subgroup, meta-regression, and sensitivity analyses were employed to ensure the robustness of findings. Additional assessments included publication bias tests and trial sequential analysis to confirm adequate sample size and reliability.

RESULTS

Of 406 identified records, 19 articles (28 studies) met inclusion criteria, revealing significantly higher VCAM-1 levels in OSA patients (SMD=1.90, 95% CI: 1.45-2.35; P<0.00001). Subgroup analyses consistently showed elevated VCAM-1 level, with variations across ethnicity and OSA severity, while sensitivity analysis confirmed robustness despite high heterogeneity (I2=94%). Publication bias and trial sequential analysis highlighted reliability but emphasized cautious interpretation of results.

CONCLUSIONS

VCAM-1 shows potential as a biomarker for OSA, indicating systemic inflammation and endothelial dysfunction linked to cardiovascular risks. Its utility in early detection and treatment development is promising, but further research is needed to validate findings across populations and explore its connection to OSA-related comorbidities for innovative therapies.