LAUSR

AIM Whether obstructive sleep apnea (OSA) actually represents an independent risk factor for aortic dilation in the general population is unclear. We investigated this issue through a review and a meta-analysis of cardiac imaging studies that provided data on this vascular phenotype measured at the root or ascending tract level. DESIGN A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception up to November 30 th 2021. Studies were identified by using the following search terms: "aortic root", "ascending aorta", "vascular damage", "echocardiography", "computed tomography", "magnetic resonance imaging", "obstructive sleep apnea", "sleep disordered breathing". RESULTS 11 studies including a total of 1860 patients with OSA (without aortic aneurysms and connective tissue diseases) and 233 non-OSA controls were considered. Aortic diameter was significantly higher in patients with OSA than in non-OSA controls (SMD=0.73±0.08, CI: 0.57-0.88, p<0.0001). This was also the case for patients with severe OSA as compared to their counterparts with mild OSA (SMD=0.42±0.07, CI: 0.28- 0.56, p <0.0001). After assessing data for publication bias, the difference between groups was still significant. CONCLUSIONS Our findings suggest an association between OSA and aortic enlargement and particularly in the severe OSA setting. However, this conclusion must be taken with caution in relation to two types of factors: I) the paucity of available data, and II) the limits deriving from the methodological differences of the various studies. Larger prospective and carefully designed studies are needed to shed light on this relevant public health topic.