Circulating malondialdehyde concentrations in obstructive sleep apnea (Osa): A systematic review and meta-analysis with meta-regression

Maria Carmina Pau, Elisabetta Zinellu, Sara S. Fois, Barbara Piras, Gianfranco Pintus, Ciriaco Carru, Arduino A. Mangoni, Alessandro G. Fois, Angelo Zinellu, Pietro Pirina

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)
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Oxidative stress induced by nocturnal intermittent hypoxia plays a significant pathophysiological role in obstructive sleep apnea (OSA). Malondialdehyde (MDA), one of the most commonly investigated markers of lipid peroxidation, might assist with the monitoring of oxidative balance in OSA. We conducted a systematic review and meta-analysis to evaluate the differences in circulating MDA concentrations between patients with OSA and non-OSA controls. A systematic search was conducted in the electronic databases Pubmed, Web of Science, Scopus and Google Scholar from inception to December 2020 by using the following terms: “malondialdehyde” or “MDA”; and “Obstructive Sleep Apnea Syndrome”, “OSAS” or “OSA”. We identified 26 studies in 1223 OSA patients and 716 controls. The pooled MDA concentrations were significantly higher in patients with OSA (standardized mean difference (SMD) 1.43 μmol/L, 95% confidence interval (CI) 1.03 to 1.83 μmol/L, p < 0.001). There was extreme heterogeneity between the studies (I2 = 92.3%, p < 0.001). In meta-regression analysis, the SMD was significantly associated with age, the assay type used and publication year. In our meta-analysis, MDA concentrations were significantly higher in OSA patients than in controls. This finding suggests that MDA, which is a marker of lipid peroxidation, is involved in the pathogenesis of OSA and provides insights for future studies investigating its potential clinical use.

Original languageEnglish
Article number1053
Number of pages18
Issue number7
Publication statusPublished - Jul 2021


  • Lipid peroxidation
  • Malondialdehyde
  • Obstructive sleep apnea
  • Oxidative stress


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