The Prevalence of Obstructive Sleep Apnea and Associated Symptoms among Patients with Sickle Cell Disease: A Systematic Review and Meta-analysis

Abstract

Previous studies have shown that patients with sickle cell disease (SCD) are at high risk for obstructive sleep apnea (OSA). In the current study, we aimed to systematically review the literature to address the prevalence of OSA and associated symptoms among patients with SCD. Electronic databases, including Web of Science, Scopus, PubMed, Google Scholar, and Embase were systematically searched to identify the relevant original articles on patients with SCD. Newcastle Ottawa scale was used for quality assessment. Data were pooled by using random effects models. Subgroup analyses were performed by age groups. Thirty-nine studies containing details of 299,358 patients with SCD were included. The pooled results showed that more than half of these patients had OSA with different severities. The prevalence rates of OSA among children with apnea hypopnea index (AHI) cutoffs of above 1, 1.5, and 5 were 51% (95% confidence interval (CI) 36–67%), 29% (95% CI 19–40%), and 18% (95% CI 14–23%), respectively. The prevalence of OSA among adults with AHI cutoff of 5 was 43% (95% CI 21–64%). The pooled rates of snoring, nocturnal enuresis, nocturnal desaturation, and daytime sleepiness were 55% (95% CI 42–69%), 37% (95% CI 33–41%), 49% (95% CI 26–72%), and 21% (95% CI 12–30%), respectively. Given the high prevalence of OSA in patients with SCD, probable greater burden of SCD complications, and irreversible consequences of OSA, screening for OSA symptoms and signs seems useful in these patients. By screening and identifying this heterogeneous disorder earlier, available treatment modalities can be individualized for each patient.

Graphical Abstract

Keywords:

• Epidemiology
• obstructive sleep apnea (OSA)
• sickle cell disease (SCD)
• sleep medicine

Acknowledgements

This work was extracted from the thesis written by Ehsan Taherifard in partial fulfillment of the requirements for the degree of doctor of medicine from Shiraz University of Medical Sciences, Shiraz, Iran (approval number: 25773). The authors would like to thank Center for Development of Clinical Research of Nemazee Hospital and Dr. Nasrin Shokrpour for editorial assistance.

Ethical approval

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

Author contributions

Conceptualization: Ehsan T, Erfan T, MHB, and SH; methodology: Ehsan T, Erfan T, MHB, MS, and SH; writing – original draft preparation: Ehsan T, Erfan T, and MHB; writing – review and editing: MS and SH; supervision: MS and SH; project administration: MS and SH. All authors have read and agreed to the published version of the manuscript.

Consent form

No informed consent is needed for a systematic review.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Data availability statement

All data generated or analyzed during this study are included in this published article [and its supplementary information files] [60].

Additional information

Funding

None.