Impact of Continuous Positive Airway Pressure Therapy on Blood Pressure in Patients with Obstructive Sleep Apnea Hypopnea: A Meta-analysis of Randomized Controlled Trials

Abstract

Patients with untreated obstructive sleep apnea hypopnea (OSAH) are predisposed to developing hypertension, and therapy with continuous positive airway pressure (CPAP) may reduce blood pressure (BP). The purpose of this study was to assess the impact of CPAP therapy on BP in patients with OSAH. We performed a comprehensive literature search up to July 2006 [Medline, PubMed, EMBASE, Cochrane Database of Systematic Reviews (CDSR), Cochrane controlled trials register (CCTR), and Database of Abstract and Reviews of Effect (DARE)] to identify clinical studies and systemic reviews that examined the impact of CPAP on BP. Studies were included if they (1) were randomized controlled trials with an appropriate control group, (2) included systolic and diastolic BP measurements before and after CPAP/control in patients with OSAH, and (3) contained adequate data to perform a meta-analysis. To calculate pooled results, studies were weighted by inverse variances, with either a fixed or a random effects model used depending on the presence of heterogeneity (assessed with Q test). Ten studies met our inclusion criteria (587 patients): three studies were crossover (149 patients) and seven were parallel in design. Seven studies (421 patients) used 24-h ambulatory BP and three used one-time measurements. Two studies were of patients with heart failure (41 patients). Overall, the effects of CPAP were modest and not statistically significant; CPAP (compared to control) reduced systolic BP (SBP) by 1.38 mmHg (95% CI: 3.6 to -0.88, p = 0.23) and diastolic BP (DBP) by 1.52 mmHg (CI: 3.1 to -0.07; p = 0.06). Six of the trials studied more severe OSAH (mean AHI > 30/h, 313 patients); in these six trials, CPAP reduced SBP by 3.03 mmHg (CI 6.7 to -0.61; p = 0.10) and DBP by 2.03 mmHg (CI: 4.1 to -0.002; p = 0.05). There was a trend for SBP reduction to be associated with CPAP compliance. In unselected patients with sleep apnea, CPAP has very modest effects on BP. However, we cannot exclude the possibility that certain subgroups of patients may have more robust responses-this may include patients with more severe OSAH or difficult-to-control hypertension. Future randomized controlled trials in this area should potentially concentrate on these subgroups of patients.

Sleep Apnea and Cardiovascular Disease

“…161 Overall, the net reduction in BP (Ϸ2 mm Hg) was significant but modest. A third meta-analysis 162 included randomized controlled trials that reported systolic and diastolic BPs before and after CPAP/control and noted modest (Ϸ1.5 mm Hg) decreases in both systolic BP (Pϭ0.23) and diastolic BP (Pϭ0.06). In 6 trials that evaluated more severe OSA (AHI Ͼ30), CPAP reduced systolic BP by Ϸ3 mm Hg (Pϭ0.10) and diastolic BP by 2 mm Hg (Pϭ0.05).…”

Avanços recentes do impacto da apneia obstrutiva do sono na hipertensão arterial sistêmica

“…All point to a blood pressure reduction with the use of CPAP. Only one of them 62 did not show a beneficial effect of CPAP treatment on blood pressure control. However, when analyzed in only 52 . six studies with more severely ill patients (AHI > 30 events/ hour), the result showed reduction in systolic blood pressure by 3.3 mmHg and in diastolic blood pressure by 2.03 mmHg.…”

“…Summarizing these findings, a systematic review 61 and four meta-analyses [62][63][64][65] assessing the impact of CPAP on blood pressure have been published in the past few years. All point to a blood pressure reduction with the use of CPAP.…”

Wytyczne ESH/ESC dotyczące postępowania w nadciśnieniu tętniczym w 2013 roku

“…Ponieważ udowodniono związek otyłości i obturacyjnego bezdechu sennego, zaleca się powszechnie obniżenie masy ciała, choć niestety nie przeprowadzono kontrolowanych badań na szeroką skalę dotyczących tego zagadnienia [521]. Skuteczną metodę leczenia zmniejszającą nasilenie obturacyjnego bezdechu sennego jest zastosowanie ciągłego dodatniego ciśnienia w drogach oddechowych, jednak na podstawie dostępnych wyników 4 metaanaliz wykazano, że wpływ przedłużonej terapii ciągłym dodatnim ciśnieniem w drogach oddechowych pozwala jedynie na niewielkie obniżenie BP (1-2 mm Hg) [522][523][524][525]. Może to wynikać ze słabej współpracy pacjentów ze względu na złożoność procedury lub ograniczonego okresu obserwacji, chociaż w ostatnim badaniu, w którym czas obserwacji wynosił ponad 3 lata, nie stwierdzono różnic w wartościach BP czy intensywności stosowanego leczenia hipotensyjnego u osób z obturacyjnym bezdechem sennym, którzy kontynuowali lub zaprzestali terapii dodatnim ciśnieniem w drogach oddechowych [526].…”