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Table 3 Characteristics of the included studies on OSA and cardiac impairment

From: Obstructive sleep apnea increases the risk of cardiovascular damage: a systematic review and meta-analysis of imaging studies

First author Year Country Sample size Subgroup Diagnosis criteria Age, years Male (%) BMI, kg/m2 Hypertension (%) Hyperlipidemia (%) Diabetes (%) ESS AHI, events/h OSA diagnosis methods NOS
Echocardiography
Arias [30] 2005 Spain 42 Control (15) AHI < 5 48 ± 9 15 (100) 28.7 ± 4.7 0 (0) NA 0 (0) NA 3.9 ± 3.3 Respiratory recording device 7
OSA (27) AHI ≥ 10 52 ± 13 27 (100) 30.5 ± 4.0 0 (0) NA 0 (0) NA 44.0 ± 27.5
Dursunoglu [31] 2005 Turkey 49 Control (20) AHI < 5 43.5 ± 6.0 15 (75) 29.3 ± 2.4 0 (0) NA 0 (0) NA 5.2 ± 2.8 PSG 8
Mild OSA (11) AHI 5–14 46.0 ± 5.6 8 (73) 30.4 ± 4.0 0 (0) NA 0 (0) NA 25.3 ± 2.6
Moderate-severe OSA (18) AHI ≥ 15 46.5 ± 4.9 14 (78) 30.6 ± 4.0 0 (0) NA 0 (0) NA 50.1 ± 11.6
Dursunoglu [32] 2005 Turkey 67 Mild OSA (16) AHI 5–14 46.0 ± 5.6 13 (81.3) 29.3 ± 2.4 4 (25) NA 0 (0) NA 5.2 ± 2.8 PSG 6
Moderate OSA (18) AHI 15–29 46.5 ± 4.9 15 (83.3) 30.4 ± 4.0 8 (44.4) NA 0 (0) NA 25.3 ± 2.6
Severe OSA (33) AHI ≥ 30 48.1 ± 6.5 28 (84.8) 30.6 ± 3.7 26 (61.9) NA 0 (0) NA 50.1 ± 11.6
Kasikcioglu [33] 2005 Turkey 28 Control (14) AHI < 5 51.8 ± 12.9 14 (100) 27.9 ± 2.5 0 (0) 0 (0) 0 (0) NA 1.7 ± 1.1 PSG 7
OSA (14) AHI > 15 49.7 ± 11.6 14 (100) 28.7 ± 2.9 0 (0) 0 (0) 0 (0) NA 32.9 ± 7.1
Tanriverdi [34] 2006 Turkey 64 Control (24) AHI < 5 51.9 ± 5.2 19 (79.2) 29.4 ± 3.9 0 (0) 0 (0) 0 (0) NA 3 ± 1.5 PSG 8
OSA (40) AHI ≥ 5 51.3 ± 9 32 (80) 29.8 ± 5.3 0 (0) 0 (0) 0 (0) NA 25.3 ± 11.4
Kasikcioglu [35] 2007 Turkey 20 Control group (10) AHI < 5 45 ± 9 10 (100) 27.7 ± 2.6 0 (0) 0 (0) 0 (0) NA 2.1 ± 1.0 PSG 7
Patient group (10) AHI > 30 42 ± 6 10 (100) 30.6 ± 3.2 0 (0) 0 (0) 0 (0) NA 43.8 ± 11.7
Ott [36] 2007 USA 41 Without OSA (18) AHI < 5 45 ± 2 18 (100) 32.3 ± 0.9 0 (0) 0 (0) 0 (0) NA 2 ± 0.4 PSG 8
Moderate to severe OSA (23) AHI ≥ 15 45 ± 3 23 (100) 33.7 ± 0.8 0 (0) 0 (0) 0 (0) NA 50 ± 7.0
Tavil [37] 2007 Turkey 41 Control (21) AHI < 5 49 ± 5 12 (57.1) 29 ± 6 NA NA 0 (0)   2 ± 2 PSG 8
OSA (20) AHI ≥ 5 50 ± 7 11 (55.0) 30 ± 7 NA NA 0 (0)   31 ± 29
Bayram [38] 2008 Turkey 46 Control (18) AHI < 5 41.9 ± 11.5 14 (77.8) 27.9 ± 2.7 0 (0) 0 (0) 0 (0) NA 2.6 ± 0.8 PSG 8
OSA (28) AHI ≥ 15 44.8 ± 10.5 23 (82.1) 29.7 ± 5.3 0 (0) 0 (0) 0 (0) NA 62.3 ± 21.6
Kim [39] 2008 Korea 62 None (24) AHI < 5 52 ± 1 24 (100) 27 ± 1 3 (13) NA 2 (8) NA 2.0 ± 0.3 PSG 8
Mild to moderate (18) 5 ≤ AHI ≤ 30 52 ± 1 18 (100) 27 ± 1 2 (11) NA 5 (28) NA 16.1 ± 1.2
Severe (20) AHI > 30 51 ± 1 20 (100) 27 ± 1 3 (15) NA 3 (15) NA 45.5 ± 3.2
Oliveira [40] 2008 Brazil 106 Control (50) AHI < 5 52.3 ± 8.5 20 (40) 27.8 ± 4.5 18 (36.0) NA 4 (8.0) NA 2.6 ± 1.4 PSG 9
OSA (56) AHI ≥ 5 52.9 ± 10.6 29 (51.8) 29.4 ± 6.3 25 (44.6) NA 4 (7.1) NA 30.3 ± 23.1
Bayram [41] 2009 Turkey 46 Control (18) AHI < 5 41.9 ± 11.5 14 (77.8) 27.9 ± 2.7 NA 0 (0) 0 (0) NA 2.6 ± 0.8 PSG 8
OSA (28) AHI ≥ 15 44.8 ± 10.5 23 (82.1) 29.7 ± 5.3 NA 0 (0) 0 (0) NA 62.3 ± 21.6
Baguet [42] 2009 France 130 Group A (65) RDI < 37 48 ± 10 52 (80) 25.6 ± 3 0 (0) 0 (0) NA NA N/A PSG or polygraphy 5
Group B (65) RDI > 37 49 ± 10 57 (88) 27.5 ± 3.5 0 (0) 0 (0) NA NA
Haruki [43] 2009 USA 49 control (20) AHI < 5 36 ± 6 19 (95) 23.4 ± 2.9 1 (5) 3 (15) 0 (0) NA 2.2 ± 1.4 PSG 8
OSA (29) AHI ≥ 5 40 ± 8 29 (100) 27.6 ± 4.3 9 (31) 22 (76) 3 (10) NA 34.7 ± 23.1
Kepez [44] 2009 USA 107 Without OSA (22) AHI < 5 46.4 ± 4.6 13 (59.1) 27.6 ± 4.0 4 (18.2) NA NA NA 2.5 ± 2.0 PSG 7
Mild to moderate OSA (45) 5 ≤ AHI < 30 48.8 ± 8.2 33 (73.3) 28.4 ± 3.4 16 (35.6) NA NA NA 15.0 ± 13.0
Severe OSA (40) AHI ≥ 30 48.6 ± 9.2 24 (60) 31.5 ± 4.9 14 (35) NA NA NA 46.0 ± 42.0
Lee [45] 2009 China 51 Control (16) AHI < 5 39 ± 7.8 13 (82) 27 ± 3.8 3 (19) 0 (0) NA NA 2 ± 1.6 PSG 8
Mild OSA (20) AHI 5–20 45 ± 9.5 17 (85) 28 ± 3.3 2 (10) 0 (0) NA NA 11 ± 4.5
Moderate to severe OSA (15) AHI > 20 46 ± 11.9 15 (100) 31 ± 5.1 8 (53) 0 (0) NA NA 48 ± 21
Tugcu [46] 2009 Turkey 71 Controls (30) AHI < 5 54 ± 10 22 (73.3) 30.10 ± 3.65 0 (0) 12 (40) 0 (0) 2.6 ± 2.29 1.46 ± 0.68 PSG 7
OSA (41) AHI ≥ 15 56 ± 12 32 (78.0) 31.38 ± 4.97 0 (0) 21 (51.2) 0 (0) 19.37 ± 4.3 38.84 ± 21.80
Tomiyama [47] 2009 Japan 164 None (14) AHI < 5 44 ± 10 12 (85.7) 23.6 ± 2.8 0 (0) 0 (0) 0 (0) 8 ± 5 2.1 ± 1.2 PSG 7
Mimo (65) 5 ≤ AHI < 30 46 ± 11 59 (90.8) 25.0 ± 3.1 0 (0) 0 (0) 0 (0) 10 ± 4 19.7 ± 6.1
Severe (85) AHI ≥ 30 49 ± 11 78 (91.8) 27.0 ± 3.7 0 (0) 0 (0) 0 (0) 11 ± 5 51.2 ± 18.1
Cioffi [48] 2010 Italy 157 Controls (20) AHI < 5 56 ± 15 16 (80) 29 ± 6 10 (50) 12 (60) 2 (10) NA 3.4 (1–10) PSG 7
Mild OSA (51) AHI 5–15 60 ± 13 41 (80) 29 ± 5 36 (71) 28 (55) 11 (21) NA 10 (6–15)
Moderate/severe OSA (86) AHI > 15 63 ± 12 73 (85) 31 ± 5 67 (78) 51 (59) 15 (17) NA 33 (23–46)
Tugcu [49] 2010 Turkey 53 Control (26) AHI < 5 54 ± 10 19 (73.1) 29.6 ± 3.6 0 (0) NA 0 (0) NA 2 ± 1 PSG 7
OSA (27) AHI ≥ 15 54 ± 10 24 (88.9) 31.1 ± 5.1 0 (0) NA 0 (0) NA 40 ± 22
Varol [50] 2010 Turkey 64 Control (18) AHI < 5 44.8 ± 11.6 13 (72) 29.2 ± 4.8 0 (0) NA 0 (0) NA 2.1 ± 1.6 PSG 8
Mild to moderate (25) 5 ≤ AHI ≤ 30 51.2 ± 8.7 19 (76) 29.9 ± 4.3 0 (0) NA 0 (0) NA 15.8 ± 7.4
Severe (21) AHI > 30 48.9 ± 9.3 18 (85) 32.2 ± 3.6 0 (0) NA 0 (0) NA 60.7 ± 24.5
Cicek [51] 2011 Turkey 90 Group A (26) AHI ≤ 5 49.4 ± 12.3 13 (50) 21.1 ± 2.3 12 (46.2) 6 (23.1) 4 (15.4) 7.5 ± 4.7 2.4 ± 1.5 PSG 7
Group B (20) 5 < AHI < 15 59.3 ± 9.5 9 (45) 23.5 ± 3.1 4 (20.0) 4 (20) 2 (10.0) 7.4 ± 4.3 8.4 ± 3.6
Group C (20) 15 ≤ AHI < 30 60.1 ± 13.5 6 (30) 26.5 ± 4.2 8 (40.0) 5 (25) 5 (25.0) 8.1 ± 4.2 25.5 ± 4.2
Group D (24) AHI ≥ 30 57.3 ± 16.2 6 (25) 30.5 ± 6.4 15 (62.5) 9 (37.5) 8 (33.3) 8.8 ± 5.9 62.9 ± 23.6
Altintas [52] 2012 USA 40 Mild OSA (7) AHI 5–14 38.3 ± 6.1 4 (57.1) 27.5 ± 5.1 1 (14.3) NA 0 (0) NA 8.5 ± 2.2 PSG 7
Moderate OSA (13) AHI 15–29 42.7 ± 9.1 10 (76.9) 31.4 ± 4.6 4 (30.8) NA 0 (0) NA 21.5 ± 3.8
Severe OSA (20) AHI ≥ 30 48.9 ± 7.4 17 (85.0) 31.5 ± 4.9 10 (50) NA 0 (0) NA 50.5 ± 15.3
Balci [53] 2012 Turkey 94 Control (33) AHI < 5 41.6 ± 11.6 16 (48.5) 26.3 ± 1.4 0 (0) 0 (0) 0 (0) NA 3.2 ± 1.9 PSG 8
Mild to moderate (30) 5 ≤ AHI < 30 42.5 ± 11.2 18 (60.0) 26.9 ± 2.4 0 (0) 0 (0) 0 (0) NA 14.2 ± 14.6
Severe (31) AHI ≥ 30 45.7 ± 10.3 16 (51.6) 27.3 ± 2.3 0 (0) 0 (0) 0 (0) NA 66.3 ± 39.9
Butt [54] 2012 UK 80 Control (40) AHI < 5 46 ± 9 30 (75) 32 ± 6 0 (0) 0 (0) 0 (0) NA 3 ± 2 PSG 8
OSA (40) AHI ≥ 15 50 ± 10 33 (82.5) 34 ± 8 0 (0) 0 (0) 0 (0) NA 39 ± 22
Cho [55] 2012 Korea 45 Control (20) AHI < 5 47.2 ± 7.1 N/A 27.9 ± 1.7 0 (0) NA 0 (0) 6.67 ± 1.11 N/A PSG 6
OSA (25) AHI ≥ 15 43.5 ± 11.3 28.0 ± 3.4 0 (0) NA 0 (0) 13.6 ± 3.4 19.7 ± 11.6
Hammerstingl [56] 2012 Germany 183 Control (29) AHI < 5 55.7 ± 15.8 17 (58.6) 30.1 ± 5.5 12 (44.4) 7 (24.1) 76 (49.4) NA 2.3 ± 1.3 PSG 8
OSA (154) AHI > 5 61.7 ± 12.4 109 (70.8) 31.1 ± 5.8 1 (3.4) 53 (34.4) 21 (13.6) NA 35.9 ± 28.4
Kim [57] 2012 Korea 49 Control (24) AHI < 5 48.42 ± 7.45 17 (79.8) 27.45 ± 2.41 0 (0) 0 (0) 0 (0) NA 2.94 ± 1.44 PSG 8
OSA (25) AHI ≥ 5 43.48 ± 11.32 20 (80) 28.1 ± 3.1 0 (0) 0 (0) 0 (0) NA 19.66 ± 11.64
Oliveira [58] 2012 Brazil 106 Control (50) AHI < 5 52.3 ± 8.5 20 (40.0) 27.8 ± 4.5 18 (36) NA 4 (8) NA 2.6 ± 1.4 PSG 8
OSA (56) AHI > 20 52.9 ± 10.6 29 (51.8) 29.4 ± 6.3 25 (44.6) NA 4 (7.1) NA 30.3 ± 23.1
Pressman [59] 2012 USA 54 None/mild OSA (14) AHI < 15 43 ± 13 3 (20) 37 ± 6 7 (50) NA 2 (14) NA 4.9 ± 4 PSG 5
Moderate/severe (40) AHI ≥ 15 45 ± 10 18 (45) 42 ± 9 24 (60) NA 10 (25) NA 50 ± 28
Yang [60] 2012 China 295 Control (75) AHI < 5 59.8 ± 1.1 61 (81.3) 26.32 ± 4.57 0 (0) NA 0 (0) NA 2.9 ± 2.0 PSG 8
OSA (220) AHI > 5 58.4 ± 0.7 179 (81.4) 27.39 ± 5.74 0 (0) NA 0 (0) NA 20.0 ± 5.6
Aslan [61] 2013 Turkey 80 Group 1 (43) AHI < 15 44.1 ± 10.9 31 (72.1) 28.48 ± 4.2 0 (0) 0 (0) 0 (0) NA 5.3 ± 4.5 PSG 5
Group 2 (37) AHI ≥ 15 46.0 ± 9.4 34 (91.9) 31.41 ± 4.8 0 (0) 0 (0) 0 (0) NA 49.2 ± 24.8
Hammerstingl [62] 2013 Germany 82 Group 1 (29) AHI 5–14 61.8 ± 13.0 21 (72.4) 28.9 ± 4.9 13 (44.8) 9 (31) 1 (3.4) 8.5 ± 4.1 9.0 ± 2.8 PSG 5
Group 1 (24) AHI 15–30 66.3 ± 10.5 13 (54.1) 30.4 ± 4.5 15 (62.5) 12 (50) 4 (16.6) 9.4 ± 4.5 22.0 ± 4.4
Group 1 (29) AHI > 30 62.5 ± 10.7 17 (58.6) 32.9 ± 6.3 16 (55.1) 9 (31) 5 (17.2) 13.6 ± 4.9 61.7 ± 22.7
Usui [63] 2013 Japan 74 Mild to moderate OSA (52) 5 ≤ AHI < 30 41.0 ± 13.1 52 (100) 24.2 ± 2.7 0 (0) 0 (0) 0 (0) NA 17.2 ± 6.9 PSG 6
Severe OSA (22) AHI ≥ 30 47.0 ± 13.5 22 (100) 24.5 ± 3.0 0 (0) 0 (0) 0 (0) NA 44.7 ± 10.3
Vitarelli [64] 2013 Italy 77 Control (35) AHI < 5 45.1 ± 12.2 13 (37.1) 26.8 ± 4.3 0 (0) 0 (0) 0 (0) NA 3.8 ± 1.1 PSG 8
Mild OSA (19) 5 ≤ AHI < 30 48.3 ± 8.2 7 (36.8) 27.5 ± 5.4 0 (0) 0 (0) 0 (0) NA 15.4 ± 2.2
Severe OSA (23) AHI ≥ 30 47.4 ± 8.1 9 (39.1) 28.3 ± 6.5 0 (0) 0 (0) 0 (0) NA 59.4 ± 9.3
Araz [65] 2014 Turkey 98 Group 1 (31) AHI < 5 49.8 ± 10.9 20 (29.9) 29.5 ± 7.3 0 (0) NA 0 (0) 3 ± 2 1.5 ± 1.4 PSG 7
Group 2 (67) AHI ≥ 5 49.7 ± 12.7 47 (70.1) 34.6 ± 8.3 0 (0) NA 0 (0) 10 ± 4 52.6 ± 32.3
Chen [66] 2014 China 79 Control group (14) AHI < 15 47 ± 8 9 (64.3) 24.1 ± 3.4 7 (50) 4 (28.6) 0 (0) NA 8.6 ± 3.8 PSG 5
OSAS group (65) AHI ≥ 15 49 ± 10 54 (83.1) 26.9 ± 3.6 32 (49.2) 17 (26.2) 0 (0) NA 45.4 ± 19.5
Danica [67] 2014 Serbia 203 Controls (78) AHI < 5 48.8 ± 10.2 36 (46.2) 24.9 ± 2.8 5 (6.4) 51 (65.4) 0 (0) NA 37.2 ± 21.7 PSG 8
Patients (125) AHI ≥ 5 51.6 ± 10.7 91 (72.8) 31.6 ± 5.6 69 (55.6) 94 (75.2) 0 (0) NA
Sun [68] 2014 China 186 Control group (50) AHI < 5 62.2 ± 10.8 37 (74.0) 29.66 ± 4.22 0 (0) NA 0 (0) NA RDI 26 ± 19 PSG 7
OSA group (136) AHI ≥ 5 63.3 ± 10.6 89 (65.4) 30.94 ± 4.15 0 (0) NA 0 (0) NA RDI 14 ± 6
Cil [69] 2015 Turkey 74 Control (30) AHI < 5 43.03 ± 10.89 25 (83.3) 30.8 ± 4.6 8 (26.7) 3 (10) 4 (13.3) NA 1.35 ± 2.94 PSG 8
OSA (44) AHI ≥ 5 49.8 ± 11.5 30 (68.2) 34.0 ± 6.7 19 (43.2) 9 (20.4) 6 (13.6) NA 28.05 ± 28.82
Imai [70] 2015 Germany 206 Mild to moderate OSA (139) 5 ≤ AHI < 30 45 ± 12 115 (83) 23.7 ± 2.8 0 (0) NA 0 (0) NA 16.0 ± 6.7 PSG 5
Severe OSA (67) AHI ≥ 30 52 ± 11 61 (91) 25.7 ± 2.4 0 (0) NA 0 (0) NA 49.4 ± 14.9
Sforza [71] 2015 France 405 Non SDB (31) AHI < 5 68.9 ± 0.7 5 (17) 24.1 ± 3.4 13 (41.9) 14 (45.2) 0 (0) 5.0 ± 3.3 3.3 ± 1.2 Respiratory monitoring 8
Mild SDB (129) 5 < AHI < 15 68.8 ± 0.7 44 (34) 24.5 ± 3.3 47 (36.4) 53 (41.1) 4 (3.1) 5.5 ± 3.4 9.8 ± 3.2
Moderate SDB (135) 15 < AHI < 30 68.9 ± 0.8 55 (41) 25.3 ± 3.7 57 (42.2) 56 (41.5) 4 (3.0) 5.9 ± 3.6 21.3 ± 4.1
Severe SDB (110) AHI ≥ 30 68.8 ± 0.8 62 (56) 26.9 ± 3.6 53 (48.6) 32 (29.4) 8 (7.3) 6.4 ± 3.7 46.0 ± 4.7
Wang [72] 2015 China 108 Control (30) AHI < 5 45 ± 6 21 (71) 25 ± 4 0 (0) NA 0 (0) NA 2.7 ± 1.2 PSG 8
Mild (26) 5 ≤ AHI < 15 48 ± 8 18 (69) 26 ± 4 0 (0) NA 0 (0) NA 10.5 ± 3.2
Moderate (29) 5 ≤ AHI < 30 45 ± 8 8 (26) 27 ± 3 0 (0) NA 0 (0) NA 18.7 ± 5.6
Severe (23) AHI ≥ 30 46 ± 6 6 (28) 27 ± 4 0 (0) NA 0 (0) NA 57.2 ± 2.6
Akyol [73] 2016 Turkey 116 Mild OSA (26) 5 ≤ AHI < 15 44.1 ± 10.2 16 (61.5) 28.5 ± 4.9 0 (0) NA 0 (0) NA 8.3 ± 2.9 PSG 5
Moderate OSA (41) 15 ≤ AHI < 30 44.2 ± 10 30 (73.2) 29.7 ± 3.3 0 (0) NA 0 (0) NA 23.1 ± 3.5
Severe OSA (49) AHI ≥ 30 46.4 ± 11.2 33 (67.3) 31 ± 2.7 0 (0) NA 0 (0) NA 51.9 ± 17.3
Altiparmak [74] 2016 Turkey 94 Control (42) AHI < 5 46 ± 7 28 (66.7) 25.8 ± 3.3 6 (14.3) NA 5 (11.9) NA N/A PSG 9
OSA (52) AHI ≥ 5 49 ± 10 35 (67.3) 26.5 ± 2.1 16 (30.8) NA 10 (19.2) NA
Altıparmak [75] 2016 Turkey 66 Control (35) AHI < 5 43.0 ± 6.4 23 (74.2) 26.2 ± 3.2 0 (0) NA 0 (0) NA N/A PSG 8
OSA (31) AHI ≥ 5 45.5 ± 6.6 25 (71.4) 26.7 ± 2.1 0 (0) NA 0 (0) NA 45.4 ± 28.1
Güvenç [76] 2016 Turkey 67 Control (26) AHI < 5 47 ± 13 19 (73) 26.01 ± 3.53 10 (3.8) NA 0 (0) NA N/A PSG 7
OSA (41) AHI ≥ 5 48 ± 9 27 (66) 32.02 ± 4.6 13 (31.6) NA 4 (10.5) NA Moderate 23.0 ± 4.5; severe 53.4 ± 18.5
Korcarz [77] 2016 USA 544 AHI < 5 (468) AHI < 5 46 ± 7 222 (47) 28.8 ± 5.9 NA NA 9 (2) NA 1.1 ± 1.3 PSG 8
AHI 5–14.9 (76) AHI 5–14.9 49 ± 8 52 (68) 31.0 ± 5.2 NA NA 1 (1) NA 8.7 ± 2.9
Li [78] 2016 China 100 Control (31) AHI < 5 46.8 ± 5.4 19 (61.3) 24.86 ± 2.78 0 (0) NA 0 (0) NA 1.72 ± 1.01 PSG 7
Mild (24) AHI 5–15 47.3 ± 6.1 15 (62.5) 26.40 ± 3.12 0 (0) NA 0 (0) NA 12.72 ± 2.03
Moderate (25) AHI 16–30 47.9 ± 7.9 15 (60) 26.83 ± 3.55 0 (0) NA 0 (0) NA 24.01 ± 3.56
Severe (20) AHI > 30 48.5 ± 5.4 12 (60) 27.97 ± 3.59 0 (0) NA 0 (0) NA 40.78 ± 5.02
Ozkececi [79] 2016 Turkey 90 Without OSA (30) AHI < 5 46.4 ± 14 14 (46.7) 29.3 ± 4.8 0 (0) NA NA NA 1 (1–4) PSG 8
OSA (60) AHI ≥ 5 49.6 ± 11.7 29 (96.7) 31.6 ± 5.8 0 (0) NA NA NA 24.5 (6–98)
Vitarelli [80] 2016 Italy 67 Control subjects (30) AHI < 5 46.2 ± 13.4 11 (36.7) 26.4 ± 4.3 0 (0) 0 (0) 0 (0) NA 3.8 ± 1.4 PSG 8
Mild OSA (10) 5 < AHI < 15 47.9 ± 10.3 4 (40) 26.9 ± 5.8 0 (0) 0 (0) 0 (0) NA 7.1 ± 1.9
Moderate OSA (8) 15 < AHI < 30 47.6 ± 9.1 3 (37.5) 27.4 ± 5.5 0 (0) 0 (0) 0 (0) NA 19.8 ± 2.7
Severe OSA (19) AHI ≥ 30 48.1 ± 10.2 7 (36.8) 28.2 ± 6.3 0 (0) 0 (0) 0 (0) NA 58.9 ± 9.1
Vural [81] 2016 Turkey 63 Non-OSA (20) AHI < 5 42.9 ± 13.1 12 (60) 26.2 ± 1.0 5 (25) 9 (45) 1 (5) NA 2.7 ± 1.0 PSG 7
Mild-to-moderate OSA (19) 5 ≤ AHI < 30 41.4 ± 12.6 12 (63.2) 26.4 ± 1.1 11 (57) 9 (47) 1 (5) NA 14.9 ± 8.3
Severe OSA (24) AHI ≥ 30 43.1 ± 11.1 13 (54.2) 26.8 ± 1.2 15 (62) 15 (62) 2 (8) NA 60.9 ± 21.3
Zhou [82] 2016 China 79 Controls (19) AHI ≤ 5 52.0 ± 10.8 12 (63.2) 24.2 ± 3.7 NA NA NA NA NA PSG 7
Mild OSA (20) 5 < AHI ≤ 15 53.9 ± 11.7 16 (80) 30.6 ± 9.7 NA NA NA NA
Moderate OSA (16) 15 < AHI ≤ 30 58.8 ± 10.7 13 (81.2) 35.0 ± 9.5 NA NA NA NA
Severe OSA (24) AHI > 30 49.7 ± 12.7 22 (91.7) 38.9 ± 9.5 NA NA NA NA
Buonauro [83] 2017 Italy 88 Control (29) AHI ≤ 5 52.9 ± 10.5 23 (79.3) 26.3 ± 3.4 NA NA NA NA NA Cardiorespiratory monitoring 6
OSA (59) AHI > 15 54.4 ± 11.2 49 (83.1) 33.2 ± 7.2 NA NA NA NA 42.0 ± 24.3
Vural [84] 2017 Turkey 162 Control (45) AHI < 5 48.1 ± 11.8 24 (53.3) 26.7 ± 1.5 10 (44.4) 21 (46.7) 4 (8.9) NA 2.8 ± 1.0 PSG 8
Mild (22) AHI 5–15 47.7 ± 11.8 14 (63.6) 27.2 ± 1.3 13 (59.1) 9 (40.9) 4 (18.2) NA 9.3 ± 3.2
Moderate (27) AHI 15–30 49.4 ± 12.1 13 (56.5) 27.2 ± 1.3 16 (69.6) 14 (60.9) 5 (21.7) NA 24.9 ± 3.9
Severe (68) AHI ≥ 30 49.9 ± 9.5 34 (59.6) 27.6 ± 2.3 31 (54.4) 26 (45.6) 9 (15.8) NA 57.3 ± 20.4
Zhou [85] 2017 China 82 Control (19) AHI ≤ 5 52.0 ± 10.8 12 (63.2) 24.2 ± 3.7 0 (0) NA 0 (0) NA NA PSG 7
Mild (21) 5 < AHI < 15 52.8 ± 11.9 15 (71.4) 29.6 ± 9.1 0 (0) NA 0 (0) NA
Moderate (19) 15 ≤ AHI < 30 55.7 ± 12.4 13 (68.4) 35.2 ± 10.1 0 (0) NA 0 (0) NA
Severe (23) AHI ≥ 30 50.2 ± 12.1 18 (78.3) 39.2 ± 9.8 0 (0) NA 0 (0) NA
Çetin [86] 2018 Turkey 55 Group I (26) AHI 5–30 49.0 ± 10.8 17 (66) 26.9 ± 1.6 12 (46) 12 (46) 4 (15) NA 8.9 ± 9.8 PSG 6
Group II (29) AHI ≥ 30 49.9 ± 9.4 15 (52) 27.2 ± 2.4 15 (51) 14 (48) 6 (20) NA 61.1 ± 21.0
Li [87] 2018 China 101 Control (30) AHI ≤ 5 46.82 ± 5.45 17 (56.7) 27.06 ± 4.38 0 (0) NA 0 (0) NA 1.75 ± 0.99 PSG 7
Mild OSA (23) AHI 5–15 47.31 ± 6.15 13 (56.5) 28.40 ± 3.12 0 (0) NA 0 (0) NA 13.96 ± 3.98
Moderate OSA (25) AHI 16–30 47.96 ± 7.90 14 (56) 29.83 ± 5.05 0 (0) NA 0 (0) NA 24.01 ± 3.56
Severe OSA (23) AHI > 30 48.55 ± 5.43 14 (60.9) 32.97 ± 3.59 0 (0) NA 0 (0) NA 39.61 ± 6.64
CMR
Javaheri [88] 2016 USA 1412 AHI < 5 (256) AHI < 5 66.2 ± 8.7 69 (27.0) 26.1 ± 5.1 126 (49.2) NA 27 (10.6) NA N/A PSG 7
AHI 5–15 (511) AHI 5–15 67.4 ± 8.6 194 (38.0) 27.7 ± 4.7 270 (52.8) NA 57 (11.2) NA
AHI 15–30 (367) AHI 15–30 69.0 ± 9.0 201 (54.8) 28.6 ± 4.8 204 (55.6) NA 59 (16.1) NA
AHI 30–50 (191) AHI 30–50 69.2 ± 9.2 124 (64.9) 29.6 ± 5.6 114 (59.7) NA 34 (17.9) NA
AHI > 50 (87) AHI > 50 68.5 ± 8.6 67 (77.0) 31.1 ± 5.2 55 (63.2) NA 194 (13.8) NA
SPECT
Wang [89] 2013 China 63 Control (17) AHI < 5 51.0 (42.0, 54.0) 13 (76.5) 28.6 (25.2, 31.3) NA NA 4 (23.5) NA 3.3 PSG 8
Mild (15) AHI 5–20 48.0 (39.0, 55.0) 10 (66.7) 28.4 (25.7, 31.7) NA NA 3 (20.0) NA 9.1
Moderate (13) AHI 21–30 44.0 (39.0, 47.0) 9 (69.2) 28.5 (27.2, 32.1) NA NA 2 (15.4) NA 38.5
Severe (18) AHI ≥ 31 45.0 (36.0, 51.0) 17 (94.4) 30.2 (28.7, 33.3) NA NA 4 (22.2) NA 65.2
  1. AHI apnea hypopnea index, BMI body mass index, IVSD interventricular septum diameter, LAD left atrial diameter, LAVI left atrial volume index, LVEDD left ventricular end-diastolic diameter, LVESD left ventricular end-systolic diameter, LVM left ventricular mass, LVMI left ventricular mass index, LV MPI left ventricular myocardial performance index, LVEF left ventricular ejection fraction, NOS Newcastle–Ottawa scale, OSA obstructive sleep apnea, PSG polysomnography, PWD posterior wall diameter, SMD standardized mean difference, RVD right ventricular diameter, RV FAC right ventricular fractional area change, RVFWT right ventricular free wall thickness, TAPSE tricuspid annular plane systolic excursion
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Systematic Reviews

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