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The worse the sleep apnea, the lower the vitamin D levels – meta-analysis 2017, 2020

Vitamin D and obstructive sleep apnea: a systematic review and meta-analysis - 2017

Sleep Medicine, online 14 December 2017, https://doi.org/10.1016/j.sleep.2017.10.016
Cindy L. Neighborsa, Michael W. Nollerb, Sungjin A. Songa, Soroush Zaghic, John Neighborsb, David Feldmand, Clete A. Kushidae, Macario Camachoa,

Vitamin D Life
Level Vit DReduction
None28 ng -
Mild27 ng3 %
Moderate 25 ng10%
Severe22 ng17 %

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Self-evaluation questions for the reader
1. Regarding the role of vitamin D insufficiency in OSAS patients, which of the following is/are correct?

  • a) Serum 25(OH)D is considered the best indicator of vitamin D status in OSAS patients.
  • b) Vitamin D deficiency and OSAS present common risk factors and comorbidities, such as older age and obesity.
  • c) There are a lack of vitamin D receptors in brain areas involved in sleep regulation.
  • d) There are no common pathogenetic features between the two conditions.

2. Which of the following is/are correct regarding the mechanism by which vitamin D insufficiency enhances the development of OSAS?

  • a) A decrease in pharyngeal dilator muscle strength, thus reducing pharyngeal patency and predisposing to apnoeic events during sleep.
  • b) An immune system dysregulation, associated with increased incidence of upper respiratory tract infections and tonsillar hypertrophy.
  • c) Promoting the secretion of pro-inflammatory cytokines.

3. Regarding the effect of obesity on serum concentrations of vitamin D, which of the following is/are correct?

  • a) In healthy individuals, serum vitamin D levels are independent from obesity.
  • b) Subcutaneous adipose tissue presents high expression of the enzymes responsible for vitamin D activation.
  • c) Fat tissue acts as a storage site for vitamin D and it is released when serum levels decrease.
  • d) Obesity may mediate the influence of CPAP therapy on vitamin D levels.

4. Regarding serum vitamin D levels in OSAS, which of the following is/are correct?

  • a) Available evidence indicates increased levels after short-term CPAP therapy.
  • b) Serum VDBP levels remain unchanged in response to chronic hypoxia.
  • c) The association between vitamin D insufficiency and hypoxia may be mediated by mechanisms involving HIF-1α and VEGF.
  • d) A positive correlation between serum vitamin D levels and inflammatory factors, such as IL-17,

PDF is available free at Sci-Hub   10.1016/j.sleep.2017.10.016

Several studies have reported an association between 25-hydroxyvitamin D (25(OH)D) levels and obstructive sleep apnea (OSA) patients. The objective of the current study was to perform a systematic review and meta-analysis of these studies and report the findings.

Authors searched for studies (through January 1, 2017) reporting 25(OH)D serum levels in OSA patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed.

Fourteen studies with 4937 subjects met inclusion criteria. There were 1513 controls and 3424 OSA patients. The 25(OH)D serum levels for controls and mild OSA patients were 28.16±9.39 ng/mL (95% CI 27.64, 28.68) and 27.41±9.42 ng/mL (95% CI 26.87, 27.95), respectively. The 25(OH)D serum levels for controls and moderate OSA patients were 28.21±9.38 ng/mL (95% CI 27.70, 28.72) and 25.48±10.34 ng/mL (95% CI 24.68, 26.28), respectively. The 25(OH)D serum levels for controls and severe OSA patients were 28.32±9.65 ng/mL (95% CI 27.80, 28.84) and 21.88±10.24 ng/mL (95% CI 21.08, 22.68), respectively. Using random effects modeling, the 25(OH)D serum levels were decreased for patients with OSA when compared to control groups (mean differences were

  • –2.7% for mild OSA,
  • –10.1% for moderate OSA and
  • –17.4% for severe OSA).

There was a relative insufficiency in serum 25(OH)D levels among OSA patients compared to control patients, which was incrementally exacerbated with increasing severity of sleep apnea. It was unclear whether a low 25(OH)D was a risk factor for OSA or if OSA was a risk factor for 25(OH)D. It was also possible that the association between 25(OH)D and OSA was due to body mass index (BMI).

The association between serum vitamin D and obstructive sleep apnea: an updated meta-analysis - 2020

Respiratory Research volume 21, Article number: 294 (2020)
Xiaoyan Li, Jie He & Jie Yun
 Download the PDF from Vitamin D Life

The objective was to determine whether OSA patients have a low serum vitamin D level by systematic review and meta-analysis.

This study searched the following electronic bibliographic databases: Embase, Medline, Web of Science, PubMed, VIP, Wanfang, CNKI and SinoMed. All data were searched between January 2000 and August 2020. The quality of the included studies was estimated by two researchers according to the Newcastle–Ottawa Scale and Agency for Healthcare Research and Quality. All qualified studies and statistical analyses were conducted using RevMan 5.2.

Twenty-nine eligible studies compromising 6717 participants met the inclusion criteria of the meta-analysis. The results revealed that the serum 25(OH)D level was significantly lower in OSA patients than the controls. According to the severity of the disease, subgroup analysis was performed; the results demonstrated that the serum 25(OH)D level was not decreased in mild OSA patients compared with the controls, while the serum 25(OH)D level in moderate and severe OSA patients was lower than that in the controls. Furthermore, based on ethnicity, BMI, PSG type, study quality and latitude, the subjects were divided into different subgroups for meta-analysis. The results revealed that the serum 25(OH)D level in all OSA subgroups was decreased compared with that in the control group.

The present meta-analysis shows that the serum vitamin D level was different between OSA patients and healthy people. OSA patients could have a low serum vitamin D level.

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