Introduction
Materials and methods
Literature retrieval strategy
Inclusion and exclusion criteria
Data extraction and quality assessment
Outcomes
Statistical analyses
Results
Study | Country | No. of participants | No. of comorbidity | No. of subjects (case/control) | Sex male(%) | Age (year) | Assessment of OSAS | Outcome | Quality score | |
---|---|---|---|---|---|---|---|---|---|---|
DM | HTN | |||||||||
Agrawal2009 [11] | USA | 91 | 31 | 55 | 36/55 | 27.1% | 44.9 ± 9.9 | PSG, AHI ≥ 5 | ③④ | 8 |
Voulgaris2018 [12] | Greece | 96 | 0 | 0 | 32/64 | 79.17% | 50.7 ± 11.98 | PSG, AHI ≥ 5 | ①② | 7 |
Chen2015 [15] | China | 457 | 0 | 457 | 106/351 | 64.11% | 20 ~ 78 | PSG, AHI ≥ 10 | ①④ | 7 |
Chen2019 [16] | China | 90 | 0 | 0 | 17/73 | NA | 42.50 ± 11.46 | PSG, AHI ≥ 10 | ①② | 7 |
Canales2011 [17] | USA | 507 | 66 | 359 | 120/387 | 100% | 76.0 ± 5.3 | PSG, RDI ≥ 5 | ② ③④ | 8 |
Zhang2013 [18] | China | 98 | 0 | 0 | 23/75 | 100% | 32.5 ± 5.19 | PSG, AHI ≥ 5 | ①② | 6 |
Faulx2007 [19] | USA | 496 | 172 | 63 | 233/263 | 44.4% | 44.5 ± 17.3 | PSG, AHI ≥ 5 | ②③ | 7 |
Archontogeorgis 2016 [20] | Greece | 84 | 0 | 0 | 20/64 | 80.95% | 51.69 ± 12.71 | PSG, AHI ≥ 5 | ①② | 7 |
Ursavas2008 [21] | Turkey | 46 | 0 | 0 | 11/35 | 100% | 45.12 ± 10.67 | PSG, AHI ≥ 5 | ③ | 6 |
Bulcun2015 [22] | Turkey | 124 | 0 | NA | 26/98 | 74.19% | 48.38 ± 11.79 | PSG, AHI ≥ 5 | ②③④ | 6 |
Song2019 [23] | China | 487 | 49 | 331 | 54/433 | 84.8% | 40.08 ± 11.6 | PSG, AHI ≥ 5 | ①② | 6 |
Zeng2017 [24] | China | 109 | 8 | 21 | 26/83 | 100% | 45.72 | PSG, AHI ≥ 5 | ②③ | 6 |
Yayan2017 [25] | Germany | 382 | NA | NA | 19/363 | 69.63% | 63.75 ± 13.85 | PSG, AHI ≥ 5 | ④ | 5 |
Uyar2015 [26] | Turkey | 696 | 0 | 275 | 62/634 | 68.1% | 51.09 ± 11.82 | PSG, AHI ≥ 5 | ③ | 6 |
Robert2017 [27] | Australia | 489 | NA | NA | 237/252 | NA | NA | PSG, AHI ≥ 10 | ④ | 8 |
Chou2011 [28] | Taiwan, China | 40 | 0 | 0 | 3/37 | 83% | 44.8 ± 8.6 | PSG, AHI ≥ 5 | ⑤ | 7 |
Kanbay2012 [29] | Turkey | 175 | 30 | 34 | 25/150 | 66.86% | 53.94 ± 12.16 | PSG, AHI ≥ 5 | ③ | 7 |
Hou2016 [30] | China | 100 | 0 | 100 | 45/55 | 60% | 55.04 ± 11.09 | PSG, AHI ≥ 5 | ① | 7 |
Serum cystatin C
Outcome | Subgroup | No. of studies | Heterogeneity | Effect size | |||
---|---|---|---|---|---|---|---|
P | I2 | Pooled SMD | 95%CI | P | |||
Serum cystatin C | Mild OSAS vs. no OSAS | 3 | 0.178 | 42.0% | 0.335 | 0.102, 0.569 | < 0.01 |
Moderate OSAS vs. no OSAS | 4 | 0.793 | 0.0% | 0.506 | 0.305, 0.706 | < 0.01 | |
Severe OSAS vs. no OSAS | 4 | 0.078 | 56.1% | 0.734 | 0.522, 0.946 | < 0.01 | |
Any stage OSAS vs. no OSAS | 3 | 0.372 | 0.0% | 0.513 | 0.297, 0.728 | < 0.01 | |
Overall | 7 | 0.106 | 33.7% | 0.530 | 0.423, 0.637 | < 0.01 | |
Hypertension with OSAS vs. hypertension with no OSAS | 3 | 0.087 | 59.1% | 0.535 | 0.268, 0.802 | < 0.01 | |
Non-hypertension with OSAS vs. non-hypertension with no OSAS | 4 | 0.984 | 0.0% | 0.730 | 0.487, 0.974 | < 0.01 | |
Overall | 7 | 0.269 | 21.0% | 0.592 | 0.433, 0.751 | < 0.01 | |
Diabetes with OSAS vs. diabetes with no OSAS | 1 | / | / | 0.381 | 0.097, 0.665 | < 0.01 | |
Non-diabetes with OSAS vs. non-diabetes with no OSAS | 6 | 0.354 | 9.6% | 0.636 | 0.470, 0.802 | < 0.01 | |
Overall | 7 | 0.269 | 21.0% | 0.592 | 0.433, 0.751 | < 0.01 | |
eGFR | Mild OSAS vs. no OSAS | 6 | 0.445 | 0.0% | − 0.122 | − 0.262, 0.018 | 0.087 |
Moderate OSAS vs. no OSAS | 7 | 0.121 | 40.6% | − 0.218 | − 0.362, − 0.073 | < 0.01 | |
severe OSAS vs. no OSAS | 7 | 0.411 | 1.8% | − 0.341 | − 0.488, − 0.193 | < 0.01 | |
Any stage OSAS vs. no OSAS | 5 | 0.077 | 52.6% | − 0.096 | − 0.250, 0.059 | 0.226 | |
Overall | 13 | 0.057 | 33.1% | − 0.194 | − 0.268, − 0.121 | < 0.01 | |
Hypertension with OSAS vs. hypertension with no OSAS | 6 | 0.057 | 53.3% | − 0.224 | − 0.387, − 0.061 | 0.007 | |
Non-hypertension with OSAS vs. non-hypertension with no OSAS | 4 | 0.097 | 52.5% | 0.006 | − 0.343, 0.354 | 0.975 | |
Overall | 10 | 0.016 | 55.8% | − 0.159 | − 0.317, − 0.002 | 0.047 | |
Diabetes with OSAS vs. diabetes with no OSAS | 5 | 0.032 | 62.2% | − 0.237 | − 0.439, − 0.035 | 0.021 | |
Non-diabetes with OSAS vs. non-diabetes with no OSAS | 6 | 0.180 | 34.2% | − 0.042 | − 0.253, 0.169 | 0.699 | |
Overall | 11 | 0.021 | 52.3% | − 0.149 | − 0.296, − 0.001 | 0.049 |
eGFR
New-onset CKD
Albuminuria
Outcome | No. of studies | No. of participants | Heterogeneity | Effect model | Effect size | |||
---|---|---|---|---|---|---|---|---|
P | I2 | WMD/RR | 95%CI | P | ||||
ACR | ||||||||
Mild OSAS vs. no OSAS | 2 | 352 | 0.594 | 0% | Random | 0.422 | 0.207, 0.637 | < 0.01 |
Moderate OSAS vs. no OSAS | 2 | 306 | 0.688 | 0% | Random | 0.886 | 0.651, 1.121 | < 0.01 |
Severe OSAS vs. no OSAS | 2 | 250 | 0.355 | 0% | Random | 1.072 | 0.801, 1.342 | < 0.01 |
Any stage OSAS vs. no OSAS | 1 | 124 | / | / | Random | 0.375 | − 0.060, 0.809 | 0.091 |
Overall | 3 | 740 | 0.003 | 69.2% | Random | 0.712 | 0.582, 0.843 | < 0.01 |
No. of MAU | 4 | 667 | 0.578 | 0% | Fixed | 2.316 | 1.480, 3.623 | < 0.01 |
Levels of MAU | 2 | 502 | 0.00 | 88.5% | Random | 0.432 | 0.276, 0.676 | < 0.01 |
Publication bias
Outcome | t | P | 95%CI |
---|---|---|---|
Serum cystatin C | |||
Mild OSAS vs. no OSAS | − 2.97 | 0.207 | − 13.346, 8.284 |
Moderate OSAS vs. no OSAS | − 2.04 | 0.179 | − 3.294, 1.178 |
Severe OSAS vs. no OSAS | − 9.19 | 0.012 | − 5.717, − 2.070 |
Any stage OSAS vs. no OSAS | − 5.65 | 0.111 | − 10.281, 3.951 |
HTN with OSAS vs. HTN with no OSAS | − 1.49 | 0.376 | − 41.470, 32.754 |
Non-HTN with OSAS vs. non-HTN with no OSAS | − 2.54 | 0.126 | − 5.693, 1.465 |
Diabetes with OSAS vs. diabetes with no OSAS | / | / | / |
Non-diabetes with OSAS vs. non-diabetes with no OSAS | − 3.50 | 0.025 | − 4.321, − 0.497 |
eGFR | |||
Mild OSAS vs. no OSAS | − 0.63 | 0.566 | − 22.362, 14.139 |
Moderate OSAS vs. no OSAS | − 0.33 | 0.756 | − 11.788, 9.120 |
Severe OSAS vs. no OSAS | 0.78 | 0.473 | − 5.835, 10.886 |
Any stage OSAS vs. no OSAS | − 0.73 | 0.516 | − 240.845, 150.567 |
HTN with OSAS vs. HTN with no OSAS | 1.08 | 0.343 | − 22.584, 51.134 |
Non-HTN with OSAS vs. non-HTN with no OSAS | − 0.54 | 0.641 | − 10.255, 7.956 |
Diabetes with OSAS vs. diabetes with no OSAS | 0.63 | 0.573 | − 33.744, 50.425 |
Non-diabetes with OSAS vs. non-diabetes with no OSAS | − 0.78 | 0.480 | − 195.660, 109.927 |
Incident CKD | 1.97 | 0.299 | − 1.986, 2.713 |
ACR | 0.59 | 0.574 | − 2.913, 4.900 |
No. of MAU | − 0.71 | 0.550 | − 6.489, 4.646 |