The effect of obstructive sleep apnea therapy on cardiovascular autonomic function: a systematic review and meta-analysis

Sleep

article

Dissanayake, Hasthi U¹  Bin, Yu Sun¹  Sutherland, Kate¹  Ucak, Seren¹  de Chazal, Philip¹  Cistulli, Peter A¹ 

[1] Sleep Research Group, Charles Perkins Centre, University of Sydney;Northern Clinical School, Faculty of Medicine and Health, University of Sydney;Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital;School of Biomedical Engineering, University of Sydney

关键词: obstructive sleep apnea;    autonomic nervous system;    sympathetic activity;    parasympathetic activity;    cardiovascular risk;    systematic review;    meta-analysis;    obstructive sleep apnea therapy;    catecholamines;    heart rate variability;   

DOI  :  10.1093/sleep/zsac210

学科分类：生理学

来源: American Academy of Sleep Medicine

【 摘 要 】

Study Objectives Autonomic function is impaired in obstructive sleep apnea (OSA) and may mediate the association between OSA and cardiovascular risk. We investigated the effect of OSA therapy on autonomic function through a systematic review and meta-analysis of intervention studies.Methods A systematic search using three databases (Medline, Embase, and Scopus) was performed up to December 9, 2020. Studies of OSA patients ≥ 18 years with autonomic function assessed before and after treatment with positive airway pressure, oral appliance, positional therapy, weight loss, or surgical intervention were included for review. Random effects meta-analysis was carried out for five groups of autonomic function indices. Risk of bias was assessed using the Cochrane Collaboration tool.Results Forty-three eligible studies were reviewed with 39 included in the meta-analysis. OSA treatment led to large decreases in muscle sympathetic nerve activity (Hedges’ g = −1.08; 95% CI −1.50, −0.65, n = 8) and moderate decreases in catecholamines (−0.60; −0.94, −0.27, n = 3) and radio nucleotide imaging (−0.61; −0.99, −0.24, n = 2). OSA therapy had no significant effect on baroreflex function (Hedges’ g = 0.15; 95% CI −0.09, 0.39, n = 6) or heart rate variability (0.02; −0.32, 0.36, n = 14). There was a significant risk of bias due to studies being primarily non-randomized trials.Conclusions OSA therapy selectively improves autonomic function measures. The strongest evidence for the effect of OSA therapy on autonomic function was seen in reduced sympathetic activity as assessed by microneurography, but without increased improvement in parasympathetic function. OSA therapy may reduce the risk of cardiovascular disease in OSA through reduced sympathetic activity.

【 授权许可】

All Rights reserved