Efficacy of continuous positive airway pressure on TNF-α in obstructive sleep apnea patients: A meta-analysis

BackgroundTumor necrosis factor-alpha (TNF-alpha) is an important mediator of the immune response. At present, the improvement of TNF-alpha after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is still controversial. MethodsWe conducted a systematic review of the present evidence based on a meta-analysis to elucidate the effects of TNF-alpha on OSAHS after CPAP treatment. ResultsTo measure TNF-alpha, ten studies used enzyme-linked immunosorbent assay (ELISA), and one used radioimmunoassay. The forest plot outcome indicated that CPAP therapy would lower the TNF-alpha levels in OSAHS patients, with a weighted mean difference (WMD) of 1.08 (95% CI: 0.62-1.55; P < 0.001) based on the REM since there is highly significant heterogeneity (I-2 = 90%) among the studies. Therefore, we used the subgroup and sensitivity analyses to investigate the source of heterogeneity. The findings of the sensitivity analysis revealed that the pooled WMD ranged from 0.91 (95% CI: 0.52-1.31; P < 0.001) to 1.18 (95% CI: 0.74-1.63; P < 0.001). The findings were not influenced by any single study. Notably, there was homogeneity in the Asia subgroup and publication year: 2019, implying that these subgroups could be the source of heterogeneity. ConclusionOur meta-analysis recommends that CPAP therapy will decrease the TNF-alpha level in OSAHS patients, but more related research should be conducted.