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International Journal of Vascular Medicine
Volume 2013, Article ID 839582, 8 pages
Review Article

Patients with Obstructive Sleep Apnea Display Increased Carotid Intima Media: A Meta-Analysis

1Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
2Pulmonary and Sleep Medicine, James A. Lovell Federal Health Care Center, 3001 Green Bay Road, North Chicago, IL 60064, USA
3Sindh Medical College, Rafiqi H. J. Road, Karachi 75510, Pakistan
4Al-Kindy College of Medicine, University of Baghdad, P.O. Box 47188, Baghdad, Iraq
5McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4L8
6Benedictine University, 5700 College Road, Lisle, IL 60532, USA

Received 7 April 2013; Revised 13 July 2013; Accepted 19 July 2013

Academic Editor: Karlheinz Peter

Copyright © 2013 Rashid Nadeem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from −0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, ( ). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process.