Serum Magnesium Levels in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis
2. Materials and Methods
2.1. Selection Criteria
2.2. Data Extraction and Meta-Analysis
2.3. Assessment of Methodological Quality
3.1. Search Results
3.2. Serum Mg and Risk of Mg Deficiency
3.2.1. Comparing to Healthy Controls
3.2.2. Meta-Analysis—Effect Size
3.2.3. Meta-Analysis—Pooled Mean
3.3. Serum Mg and OSA Severity
3.3.2. Before and after Treatment
3.4. Serum Mg and Biomarkers
3.4.1. Lipid Profile
3.4.2. Glucose Metabolism
3.4.3. Trace Minerals and Heavy Metals
3.4.4. C-Reactive Protein, Ischemia-Modified Albumin, and Carotid Intima-Media Thickness
3.5. Quality Assessment
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
|AUROC||Area under the receiver operating characteristics|
|BMI||Body mass index|
|CPAP||Continuous positive airway pressure|
|CIMT||Carotid intima-media thickness|
|ESR||Erythrocyte sedimentation rate|
|hsCRP||high sensitivity CRP|
|OSA||Obstructive sleep apnoea|
|PWV||Pulse wave velocity|
|RYGB||Roux-en-Y gastric bypass|
|T2DM||Type 2 diabetes mellitus|
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|Study and Design||Participants||Objective||Findings: Mean Serum Mg (mg/dL) and Metabolic Parameters||Ref.|
Cross-sectional case-control study
|OSA: AHI ≥ 30, n = 61. Male/Female: 42/19. Mean age: 48.2 ± 9.1. |
Control: healthy volunteers, n = 36. Male/Female: 11/25. Mean age: 46.9 ± 10.2.
|Evaluation of serum levels of trace minerals and heavy metals in severe OSA patients before any therapeutic intervention.||OSA: 1.413 ± 0.488; Control: 1.12 ± 0.722; OSA > Control (p < 0.001).|
The OSA group had significantly higher cholesterol, triglycerides, trace minerals, heavy minerals, and CIMT compared to the control (p < 0.005 for all). CIMT and triglycerides were positively correlated with Mg. HDL was negatively correlated with Mg.
Case-control follow up observational study
|OSA patients (AHI ≥ 5) with obesity and T2DM receiving RYGB surgery, n = 39. Male/Female: 15/24. Mean age: 44.20 ± 8.95 (Males); 50.50 ± 12.29 (Females).||Assessing the efficacy of RYGB surgery on patients with OSA using PSG and biochemical tests (including Mg levels), pre- and post-surgery. Study duration: 6–12 months post-intervention.||Preoperative: 2.04 ± 0.17; Postoperative: 2.19 ± 0.17; Post > Pre (p < 0.001).|
RYGB surgery significantly lowered the AHI and BMI in OSA patients. Postoperative blood Mg levels were significantly increased in OSA patients when compared to the time of diagnosis (p < 0.05). Mg was not correlated with the improvement in AHI.
Retrospective cross-sectional study
|OSA: AHI ≥ 5, n = 68. Male/Female: 46/22. |
Control: healthy volunteers, n = 30. Male/Female: 14/16.
|To evaluate the relationship between serum levels of Mg and the inflammatory response (CRP) in patients with newly diagnosed OSA.||OSA: 1.71 ± 0.21; Control: 2.19 ± 0.36; OSA < Control (p < 0.0001).|
Mg levels were lower in OSA patients than those in controls. Those with severe OSA also had significantly lower Mg (p = 0.03) than those with mild OSA. OSA group had a significantly higher CRP. A significant negative correlation was observed between Mg and CRP levels (p < 0.0001).
Case-control study with subgroup follow-up
|OSA: AHI ≥ 5, n = 33. Male/Female: 23/10. Mean age: 51.6 ± 9.8. |
Control: healthy volunteers, n = 30. Male/Female: 21/9. Mean age: 52.1 ± 10.9.
|Investigating Mg, hsCRP, and IMA as a non-invasive diagnosis method for OSA. Participants followed up after 3 months of CPAP treatment.||OSA: 1.71 ± 0.21; Control: 2.19 ± 0.36; OSA < Control (p = 0.021). Post-CPAP: 2.02 ± 0.25 (n = 22 only); Post > Baseline (p < 0.001)
OSA patients had significantly higher levels of hsCRP and IMA and significantly lower Mg compared to control (p < 0.05 for all). Mg, hsCRP, and IMA were used in a novel model to diagnose OSA with AUROC of 0.93 (0.83–0.98). OSA patients showed significant improvements in Mg, hsCRP, and IMA after CPAP treatment.
Clinical case-control study
|OSA: AHI ≥ 5, n = 70 (55 severe, 11 moderate and 4 mild). Male only. Mean age: 47.57 ± 12.15. |
Control: non-apnoeic individuals (AHI < 5), n = 30. Male only. Mean age: 43.23 ± 10.5.
|Comparing OSA patients’ metabolic markers (BMI, PSG, insulin sensitivity–resistance markers, lipid profiles) and mineral levels with those of control subjects.||OSA: 2.0 ± 0.12; Control: 2.04 ± 0.19.
There were no statistically significant differences in serum Mg, Ca, and Ca/Mg ratios between OSA patients and controls. Fasting glucose and insulin levels were significantly higher in the OSA group (p < 0.05 for all). Fasting glucose levels were correlated with Ca, Mg, and Ca/Mg ratios. Severe OSA patients had significantly higher Ca/Mg ratios than mild/moderate groups (p = 0.017).
Cross-sectional, single cohort study
|OSA: AHI ≥ 5, n = 41 (23 severe and 18 moderate/mild). Mean age: 55.83 (moderate/mild), 57.34 (severe).||Assessed the relationship between OSA severity, arterial stiffness and clinic-biological parameters in moderate-severe OSA patients prior to the use of CPAP therapy.||Moderate: 2.09; Severe: 1.9; SD not reported. Between-group not significant with p = 0.1. |
No significant difference was found between severe and moderate groups in Mg levels. ESR was significantly higher in the severe group (p = 0.012). Inflammation markers (CRP and ESR) were correlated with OSA severity. Mg was negatively correlated with PWV, which measured arterial stiffness.
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Al Wadee, Z.; Ooi, S.L.; Pak, S.C. Serum Magnesium Levels in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Biomedicines 2022, 10, 2273. https://doi.org/10.3390/biomedicines10092273
Al Wadee Z, Ooi SL, Pak SC. Serum Magnesium Levels in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Biomedicines. 2022; 10(9):2273. https://doi.org/10.3390/biomedicines10092273Chicago/Turabian Style
Al Wadee, Zahraa, Soo Liang Ooi, and Sok Cheon Pak. 2022. "Serum Magnesium Levels in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis" Biomedicines 10, no. 9: 2273. https://doi.org/10.3390/biomedicines10092273