Effect of Obstructive Sleep Apnea Hypopnea Syndrome on Lipid Profile: A Meta-Regression Analysis

Study Questions:

Does obstructive sleep apnea (OSA) adversely affect the degree of dyslipidemia?

Methods:

Two authors conducted a systematic literature review, scoring each article for inclusion. Articles were excluded for the following reasons: full text not available, non-English manuscript, inappropriate population, data not extractable, or missing relevant information. OSA was defined as more than five events/hour of sleep. Endpoints included total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG).

Results:

A total of 96 studies were reviewed, with 64 studies pooled. The final meta-analysis was performed on 18,116 patients, including controls (n = 10,145) and OSA subjects (n = 7,971). Total cholesterol pooled standardized difference in means was 0.267 (p = 0.001). LDL cholesterol pooled standardized difference in means was 0.296 (p = 0.001). HDL cholesterol pooled standardized difference in means was -0.433 (p = 0.001). TG pooled standardized difference in means was 0.603 (p = 0.001). Meta-regression showed that age has a significant effect for TC, LDL, and HDL. Body mass index had a significant effect for LDL and HDL, whereas apnea-hypopnea index had a significant effect for LDL and TG.

Conclusions:

The authors concluded that patients with OSA have increased dyslipidemia, including higher total cholesterol, LDL, and TG, as well as lower HDL.

Perspective:

A causal relationship between OSA and dyslipidemia has not been demonstrated, but is likely to be associated with chronic intermittent hypoxia, which can lead to reactive oxidative species and higher levels of inflammatory markers. These findings provide additional evidence that OSA does impact major risk factors for heart disease. Drilling down into severity of OSA and the level of dyslipidemia will be the focus of future studies, as well as to determine whether treated OSA results in lower cholesterol levels.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins, Sleep Apnea

Keywords: Lipoproteins, LDL, Cholesterol, Dyslipidemias, Body Mass Index, Lipoproteins, HDL, Triglycerides, Sleep Apnea, Obstructive


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