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SLEEP APNEA AS A RISK FACTOR FOR DIASTOLIC DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
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  • Mohammed Al-Sadawi,
  • Kleanthis Theodoropoulos,
  • farzane saeidifard,
  • Adekunle Kiladejo,
  • Patricia Erwin,
  • Mohammad Al-Ajam,
  • Louis Salciccioli,
  • Adam Budzikowski
Mohammed Al-Sadawi
Stony Brook Medicine
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Kleanthis Theodoropoulos
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farzane saeidifard
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Adekunle Kiladejo
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Patricia Erwin
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Mohammad Al-Ajam
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Louis Salciccioli
SUNY Downstate Medical Center
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Adam Budzikowski
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Abstract

Abstract: Background: This meta-analysis assessed the relationship between Obstructive Sleep Apnea (OSA) and echocardiographic parameters of diastolic dysfunction (DD), which are used in the assessment of Heart Failure with Preserved Ejection Fraction (HFpEF). Methods: We searched the databases including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 26th, 2020. The search was not restricted to time, publication status or language. Comparisons were made between patients with OSA, diagnosed in-laboratory polysomnography (PSG) or home sleep apnea testing (HSAT), and patients without OSA in relation to established markers of diastolic dysfunction. Results: Primary search identified 2512 studies. A total of 18 studies including 2509 participants were included. The two groups were free of conventional cardiovascular risk factors. Significant structural changes were observed between the two groups. Patients with OSA exhibited greater LAVI (3.94 CI [0.8, 7.07]; p=0.000) and left ventricular mass index (11.10 CI [2.56,19.65]; p=0.000) as compared to control group. The presence of OSA was also associated with more prolonged DT (10.44 ms CI [0.71,20.16]; p=0.04), IVRT (7.85 ms CI[4.48, 11.22]; p=0.000), and lower E/A ratio (-0.62 CI [-1,-0.24]; p=0.001) suggestive of early DD. The E/e’ ratio (0.94 CI[0.44, 1.45]; p=0.000) was increased. Conclusion: An association between OSA and echocardiographic parameters of DD was detected that was independent of conventional cardiovascular risk factors. OSA may be independently associated with DD perhaps due to higher LV mass. Investigating the role of CPAP therapy in reversing or ameliorating diastolic dysfunction is recommended.

Peer review status:Published

01 Apr 2021Submitted to Echocardiography
01 Apr 2021Assigned to Editor
01 Apr 2021Submission Checks Completed
18 Apr 2021Reviewer(s) Assigned
Mar 2020Published in Journal of the American College of Cardiology volume 75 issue 11 on pages 1665. 10.1016/S0735-1097(20)32292-0