Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Khurshid, Kiran; Yabes, Jonathan G.; Weiss, Patricia M; Dharia, Sushma M.; Brown, Lee K.; Unruh, Mark; Jhamb, Manisha

doi:10.5664/jcsm.6054

Cited by 29 publications

(13 citation statements)

References 54 publications

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“…Although the improvement of OSAHS is closely correlated to the degree of weight loss, the mechanism for improvement in AHI and LSpO 2 by dapagliflozin in the present study remains unclear. Weight loss maybe one reason, but the change in body composition may have been more important than the reduction in BMI 20–22 . Several researches have suggested that diuretic therapy can cause a decrease in AHI in patients with OSAHS, without a marked reduction in body weight 23–26 .…”

Section: Discussionmentioning

confidence: 99%

Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study

et al. 2019

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ObjectiveThe aim of this case-control study was to assess the efficacy of dapagliflozin combined with metformin for type-2 diabetes mellitus (T2DM) with obstructive sleep apnea hypopnea syndrome (OSAHS).MethodsA total of 36 patients with newly-diagnosed T2DM and OSAHS were randomized divided into two groups. Eighteen OSAHS patients with T2DM, who were treated with dapagliflozin and metformin, were assigned as the dapagliflozin group. These patients were given dapagliflozin and metformin for 24 weeks between February 2017 and February 2018. Another 18 OSAHS patients with T2DM, who were treated with glimepiride and metformin for 24 weeks, were assigned as the control group. Fasting plasma glucose (FPG) level, postprandial blood glucose (PPG), hemoglobin A1C (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, body mass index (BMI), blood pressure, apnea-hypopnea index (AHI), minimum oxygen saturation (LSpO2), and Epworth Somnolence Scale (ESS) score were measured before and at 24 weeks after the initiation of treatment.ResultsIn the dapagliflozin group, triglyceride (TG), systolic pressure (SBP) and diastolic pressure (DBP) significantly decreased following treatment, while high-density lipoprotein cholesterol (HDL-C) significantly increased (P < 0.05). Furthermore, a reduction in AHI, an increase in LSpO2 and a decrease in ESS score were observed in the dapagliflozin group (P < 0.05), but not in the control group. Moreover, blood glucose, HbA1c, HOMA-IR, and BMI significantly decreased in these two groups, and the decrease was more significant in the dapagliflozin group.ConclusionThese present results indicate that dapagliflozin can significantly reduce glucose, BMI, blood pressure and AHI, and improve hypoxemia during sleep and excessive daytime sleepiness, which thereby has potential as an effective treatment approach for OSAHS.

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Section: Discussionmentioning

confidence: 99%

Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study

et al. 2019

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“…OSA patients with resistant hypertension showed a quite large decrease in blood pressure during CPAP [26]. Antihypertensive drugs, and diuretics in particular, may slightly decrease AHI in OSA [27]. In general, pharmacological treatment to control hypertension is necessary in hypertensive OSA patients, given the small effects of CPAP on blood pressure [28, 29].…”

Section: Common Comorbidities In Osa Patientsmentioning

confidence: 99%

Obstructive sleep apnea and comorbidities: a dangerous liaison

Bonsignore

Baiamonte

Mazzuca

et al. 2019

Multidiscip Respir Med

187

116

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Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

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“…The relationship between OSA and hypertension can be bidirectional as intensive blood pressure reductions may influence OSA by stabilizing the upper airways (36). On the other hand, several studies on animals have demonstrated that acute increases in systemic blood pressure cause an inhibitory effect on the EMG of upper airway muscles in cats (37), and anaesthetised dogs (38), thereby facilitating sleep apnea.…”

Section: Bi-directional Relationship Between Osa and Hypertensionmentioning

confidence: 99%

Systemic hypertension in obstructive sleep apnea

Lombardi¹,

Pengo²,

Parati³

2018

J. Thorac. Dis

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There is consistent epidemiological evidence that sleep disordered breathing and systemic arterial hypertension are deeply associated, being linked through a bidirectional complex interaction among multiple mechanisms including autonomic nervous system alterations, inflammation, hormonal and hemodynamic components, sleep alterations. However there are several unanswered questions not only from a pathophysiological perspective, but also regarding the effects of obstructive sleep apnea (OSA) treatment on arterial blood pressure values. At present, while many studies have supported the possibility to obtain at least a small blood pressure reduction with OSA treatment, in particular in hypertensive patients, large trials have not clearly confirmed a significant anti-hypertensive effect, nor a beneficial effect of this intervention on cardiovascular endpoints including cardiovascular mortality. Aim of the present review article is to address the relationship between OSA and hypertension in the light of the latest evidence in the field. Moreover we will discuss research topics which need to be investigated in the future, in order to better clarify still pending issues with the aim of obtaining an early diagnosis, a more suitable phenotyping including comorbidities, and better strategies to improve patients' compliance and adherence to treatment.

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Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Abstract: Collectively, findings from these relatively small, short-term studies tend to support the contention that treatment with antihypertensive agents confers a statistically significant, albeit small, reduction in the severity of OSA, which may be more pronounced with the use of diuretics.

Cited by 29 publications

References 54 publications

Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study

Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study

Obstructive sleep apnea and comorbidities: a dangerous liaison

Systemic hypertension in obstructive sleep apnea

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