Obstructive sleep apnoea syndrome and endothelial function: potential impact of different treatment strategies—meta-analysis of prospective studies

  • Giovanni CammarotoEmail author
  • Francesco Costa
  • Maria Victoria Garcia Ruiz
  • Giuseppe Andò
  • Claudio Vicini
  • Filippo Montevecchi
  • Claudio Galletti
  • Francesco Galletti
  • Marco Valgimigli
Head and Neck
Part of the following topical collections:
  1. Sleep Apnea Syndrome: From the pathogenesis to the last therapies



Previous studies have shown an association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular events. Whether this association is mediated by an impairment of endothelial function, which is itself a driver of elevated cardiovascular risk, has yet to be clarified, as it is the eventual protective role of several OSAS treatments. The aim of our meta-analysis is to evaluate the effect of various OSAS treatments on endothelial function calculated by means of flow-mediated dilatation (FMD).


We conducted a meta-analysis of prospective studies including patients affected by mild to severe OSAS treated with continuous positive airway pressure (CPAP), surgery, oral appliance and medical treatments. FMD was measured before and after treatment


After pooling results from different treatment strategies, OSAS treatment showed a positive impact on endothelial function (Mean Difference [MD] = 2.58; 95% CI 1.95–3.20; p < 0.00001).


Our study supports the hypothesis that several modalities of treatment for OSAS positively impact endothelial function. Whether this effect also associates with an improvement of clinical outcomes remains to be ascertained.


OSAS Endothelial function CPAP Oral appliance Surgery Meta-analysis 



Obstructive sleep apnoea syndrome


Continuous positive airway pressure


Flow-mediated dilatation


Systematic Reviews and Meta-analyses (PRISMA) Statement


Meta-analysis of Observational Studies in Epidemiology




Mandibular advancement device


Randomized clinical trials



No funding was received for this research.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

This article does not contain any studies with human participants or animal performed by any of the authors.

Informed consent

This article does not contain any studies with human participants or animal performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Giovanni Cammaroto
    • 1
    • 2
    Email author
  • Francesco Costa
    • 3
    • 4
  • Maria Victoria Garcia Ruiz
    • 5
  • Giuseppe Andò
    • 4
  • Claudio Vicini
    • 2
  • Filippo Montevecchi
    • 2
  • Claudio Galletti
    • 6
  • Francesco Galletti
    • 1
  • Marco Valgimigli
    • 7
  1. 1.Department of OtolaryngologyUniversity of MessinaMessinaItaly
  2. 2.Department of OtolaryngologyHospital Morgagni PierantoniForlìItaly
  3. 3.Institut Clinic Cardiovascular, Hospital Clinic, Institut D’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)IDIBAPS, University of BarcelonaBarcelonaSpain
  4. 4.Department of Clinical and Experimental MedicinePoliclinic “G. Martino”, University of MessinaMessinaItaly
  5. 5.Área del Corazón, Hospital Universitario Virgen de La VictoriaMálagaSpain
  6. 6.Department of AnaesthesiologyUniversity of MessinaMessinaItaly
  7. 7.Swiss Cardiovascular Center BernBern University HospitalBernSwitzerland

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