The association between obstructive sleep apnea and metabolic syndrome: a systematic review and meta-analysis

Shaoyong Xu, Yi Wan, Ming Xu, Jie Ming, Ying Xing, Fei An, Qiuhe Ji

Obstructive sleep apnea (OSA) is characterized by repeated episodes of obstruction of the upper airway. Numerous studies have indicated a relationship between OSA and metabolic syndrome (MS), but the results remain debatable. We aimed to perform a systematic review and meta-analysis to evaluate the association between OSA and MS. We searched electronic databases (PubMed, EMBASE, and ISO Web of Knowledge) up to September 2014 with English-language restriction. Cross-sectional, case-control, and cohort studies in which the presence of OSA was assessed by objective measurements, the exposure of interest was OSA, and the outcome of interest was the presence (or incidence) of MS were included. The adjusted odds ratios (ORs) (or relative risk) and 95 % confidence intervals (CIs) were extracted and pooled. Sensitivity analyses were conducted, and heterogeneity and publication bias were assessed. Overall, 15 cross-sectional (2456 patients with OSA and 1705 subjects without OSA), five case-control (1156 OSA patients and 404 controls), and no cohort studies were included. The pooled ORs of MS in individuals with OSA for cross-sectional and case-control studies were 2.87 (95 % CI: 2.41-3.42) and 2.56 (95 % CI: 1.98-3.31), respectively. There was clinically unimportant (I (2)  = 20 %) and moderate (I (2)  = 35 %) between-study heterogeneity of the analysis. The pooled crude ORs of MS in individuals with mild and moderate-to-severe OSA was 2.39 (95 % CI: 1.65-3.46) and 3.45 (95 % CI: 2.33-5.12), respectively, and there was substantial heterogeneity in the meta-analyses (I (2)  = 53 % and I (2)  = 63 %, respectively). However, no evidence of publication bias was detected. OSA is shown to be associated with MS, although causality between these two factors has not been demonstrated yet. Future cohort and randomized controlled studies are needed.