Targeting Concentric Left Ventricular Hypertrophy in Obstructive Sleep Apnea Syndrome. A Meta-analysis of Echocardiographic Studies

AIM: We assessed the association between obstructive sleep apnea (OSA) and left ventricular hypertrophy subtypes (i.e. concentric and eccentric LVH) trough a meta-analysis of echocardiographic studies. DESIGN: The PubMed, OVID-MEDLINE, and Cochrane library databases were systematically analyzed to search full papers published from 1st January 2000 to 31st August 2019. Studies were detected by using the following terms: "obstructive sleep apnea", "sleep disordered breathing","left ventricular mass", "left ventricular geometry" "left ventricular hypertrophy", "echocardiography". RESULTS: Meta-analysis included 1,760 patients with OSA and 1,284 non-OSA controls from 9 studies. The prevalence rates of concentric and eccentric LVH in the pooled OSA population were 24.0% (CI 16.0%-33.0%) and 16.0% (CI 12.0%-23.0%), respectively. Meta-analysis of 6 studies comparing the prevalence of LVH subtypes in participants with OSA and controls showed that OSA was associated with an increased risk of both concentric (OR =1.62, CI: 1.27-2.07, p<0.0001) and eccentric (OR=1.34, CI: 1.07-1.67, p <0.009) LVH, respectively. CONCLUSIONS: . Our findings suggest that in the OSA setting concentric LVH is more frequent than eccentric LVH. From a practical perspective, in consideration of the particularly adverse prognostic significance of concentric LVH, a comprehensive echocardiographic evaluation targeting LVH subtypes could improve cardiovascular risk stratification in patients with OSA.