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The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review

Abstract

Background:

Obstructive sleep apnea (OSA) is a highly prevalent sleep-disordered breathing. It is associated with adverse co-morbidities, being the most scientific evidence of cardiovascular (CV) disease. Currently, OSA is measured through the apnea-hypopnea index (AHI), the total number of respiratory events per hour of sleep. However, different studies have questioned its utility in OSA management, highlighting the need to search for new parameters that better reflect the heterogeneity of the disease. Hypoxic burden (HB) has emerged as a novel biomarker that informs about the frequency, duration and depth of the desaturation related to the respiratory events. We conducted a systematic review in order to find publications about the heterogeneity of OSA measured by HB and its associations with future disease.

Methods:

Systematic review was conducted using PubMed and Web of Science. The terms “sleep apne” and “hypoxic burden” were used to look for publications from the date of inception to August 15, 2023. Inclusion criteria: articles in English published in peer-reviewed journals. Exclusion criteria: (1) not available publications; (2) duplicated articles; (3) letters, editorials, and congress communications; (4) articles not including information about HB as a specific biomarker of OSA.

Results:

33 studies were included. The results were classified in 2 main sections: (1) HB implication in the CV sphere: HB showed to be a better predictor of CV risk in OSA patients than traditional measures such as AHI with possible clinical management implication in OSA. (2) HB response to OSA treatment: pharmacological and nonpharmacological treatments have demonstrated to be effective in improving hypoxia measured through the HB.

Conclusions:

HB could be a better and more effective parameter than traditional measurements in terms of diagnosis, risk prediction and therapeutic decisions in patients with OSA. This measure could be incorporated in sleep units and could play a role in OSA management, driving the clinic to a more personalized medicine.

Article type: Systematic Review

Keywords: hypoxic burden, cardiovascular, sleep apnea, biomarkers, clinical practice

Authors: Carlota Coso, Esther Solano-Pérez, Sofía Romero-Peralta, María Castillo-García, Laura Silgado-Martínez, Sonia López-Monzoni, Pilar Resano-Barrio, Irene Cano-Pumarega, Manuel Sánchez-de-la-Torre, Olga Mediano

Affiliations: Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), 45071 Toledo, Spain; Sleep Research Institute, 28036 Madrid, Spain; Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain; Sleep Unit, Pneumology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; Precision Medicine Group in Chronic Diseases, Respiratory Department, Hospital Universitario Arnau de Vilanova y Santa María, 5198 Lleida, Spain; Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Universidad de Lleida, IRBLleida, 25002 Lleida, Spain

License: Copyright: © 2024 The Author(s). Published by IMR Press. CC BY 4.0 This is an open access article under the CC BY 4.0 license.

Article links: DOI: 10.31083/j.rcm2505172  |  PubMed: 39076480  |  PMC: PMC11267182

Relevance: Moderate: mentioned 3+ times in text

Full text: PDF (1.4 MB)

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