An umbrella review of systematic reviews and meta-analyses of observational investigations of obstructive sleep apnea and health outcomes

Abstract

Purpose The previous analysis of systematic reviews and meta-analyses have illustrated that obstructive sleep apnea (OSA) is correlated with multiple health outcomes. In the present research, our main aim was to execute an umbrella review to assess the available evidence for the associations between OSA and health outcomes. Methods Herein, a meta-analysis of previous observational investigations that have reported associations between OSA and health outcomes in all human populations and settings was performed. We used these studies to execute an umbrella review of available meta-analyses and systematic reviews. Results Sixty-six articles comprising 136 unique outcomes were enrolled in this analysis. Of the 136 unique outcomes, 111 unique outcomes had significant associations (p < 0.05). Only 7 outcomes (coronary revascularization after PCI, postoperative respiratory failure, steatosis, alaninetrans aminase (ALT) elevation, metabolic syndrome (MS), psoriasis, and Parkinson’s disease) had a high quality of evidence. Twenty-four outcomes had a moderate quality of evidence, and the remaining 80 outcomes had a weak quality of evidence. Sixty-nine outcomes exhibited significant heterogeneity. Twenty-five outcomes exhibited publication bias. Sixty-three (95%) studies showed critically low methodological quality. Conclusion Among the 66 meta-analyses exploring 136 unique outcomes, only 7 statistically significant outcomes were rated as high quality of evidence. OSA may correlate with an increased risk of coronary revascularization after PCI, postoperative respiratory failure, steatosis, ALT elevation, MS, psoriasis, and Parkinson’s disease.

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“…Our results are in line with previous studies that failed to demonstrate a link between the occurrence of OSA and more severe neuropsychiatric symptoms [64,65], whereas the absence of a relationship with cognition seems to be in contrast with previous results in both PD [2] and non-PD populations [66][67][68]. It should be noted that the cross-sectional methodology we employed in the present meta-analysis might have affected this result, because a recent study performed by Meira et al [32] Although OSA does not appear to affect patients' QoL, the possible detrimental effect of intermittent hypoxia on the brain, which is already vulnerable to PD degenerative processes, should not be underestimated due to its prevalence and adverse consequences [2,69].…”

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