Meta‐analysis of changes in the levels of catecholamines and blood pressure with continuous positive airway pressure therapy in obstructive sleep apnea

Green, Mackenzie; Ken‐Dror, Gie; Fluck, David; Sada, Charif; Sharma, Pankaj; Fry, Christopher; Han, Thang S.

doi:10.1111/jch.14061

Cited by 12 publications

(9 citation statements)

References 59 publications

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“…Excluding the study using salivary cortisol from the rest of the forest plot in PCS, or splitting the six RCT into plasma and salivary cortisol studies showed and blood pressure was also reduced by CPAP treatment. 50,51 The reduction of 5.4 mmHg of SBP and 3.3 mmHg DBP by CPAP in the present study was remarkably similar to the results observed in our previous meta-analysis of CPAP and catecholamines. 50 These together suggest that CPAP reduces stress induced by OSA.…”

Section: Discussionsupporting

confidence: 91%

“…50,51 The reduction of 5.4 mmHg of SBP and 3.3 mmHg DBP by CPAP in the present study was remarkably similar to the results observed in our previous meta-analysis of CPAP and catecholamines. 50 These together suggest that CPAP reduces stress induced by OSA. In response, secretion of stress hormones such as cortisol and catecholamines are also decreased.…”

Section: Discussionsupporting

confidence: 91%

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Changes in cortisol levels by continuous positive airway pressure in patients with obstructive sleep apnoea: Meta‐analysis of 637 individuals

Ken‐Dror

Fry

Murray

et al. 2021

Clinical Endocrinology

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Background: Obesity, obstructive sleep apnoea (OSA) and hypertension frequently coexist and are associated with elevated cortisol levels. Identification and treatment of such patients is important when investigating for suspected Cushing's syndrome and hypertension. Studies of the impact of continuous positive airway pressure (CPAP) on cortisol and blood pressure are limited by the small sample size and show conflicting findings. We conducted a meta-analysis to document changes in the levels of cortisol and blood pressure in response to CPAP treatment of OSA.Methods: Meta-analysis was conducted using RevMan (v5.3) and expressed in standardized mean difference (SMD) for catecholamines and mean difference for systolic (SBP) and diastolic blood pressure (DBP). The quality of the studies was evaluated using standard tools for assessing the risk of bias.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Changes in cortisol levels by continuous positive airway pressure in patients with obstructive sleep apnoea: Meta‐analysis of 637 individuals

Ken‐Dror

Fry

Murray

et al. 2021

Clinical Endocrinology

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“…Several meta‐analyses showing a beneficial effect of CPAP therapy on BP reduction have been reported. 7 , 21 , 22 However, in those studies, the evaluation of BP was performed by office BP and/or ambulatory BP monitoring. Evidence of an association between morning home BP and the progression of target organ damage or cardiovascular events has been accumulating.…”

Section: Discussionmentioning

confidence: 99%

Association of Night‐to‐Night Adherence of Continuous Positive Airway Pressure With Day‐to‐Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea

Hoshide

Yoshida²,

Mizuno

et al. 2022

JAHA

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Background The aim of this study was to investigate the association between night‐to‐night adherence to continuous positive airway pressure (CPAP) therapy and both home blood pressure (BP) level on the following day and seasonal variation in home BP in patients with obstructive sleep apnea. Methods and Results We analyzed 105 participants who had been diagnosed with obstructive sleep apnea (average apnea‐hypopnea index, 49.7±18.4 per hour) and who were already receiving CPAP therapy. Home BP (twice every morning and evening) and CPAP adherence data were automatically transmitted to a server for 1 year. A mixed‐effects model for repeated measures analysis was used to examine associations of night‐to‐night good CPAP adherence with day‐to‐day home BP within the same patient after adjusting for covariates. The average number of days in which patients achieved both CPAP adherence and morning or evening home BP measurement was 206.6±122.7 days (21 487 readings) and 191.2±126.3 days (20 170 readings), respectively. Good CPAP adherence (>4 hours per night of use) was achieved on the evening or morning before home BP measurements (86.8% and 86.9%, respectively). After adjustment for confounders, good CPAP adherence was negatively associated with morning home systolic BP (β, −0.663; P =0.004) and diastolic BP (β, −0.829; P <0.001). Morning home systolic BP in winter in the individuals with good CPAP adherence was significantly lower than that in individuals without such adherence ( P <0.05). These associations were not found in evening home BP. Conclusions Good adherence to CPAP therapy was negatively associated with morning home BP on the following day in patients with obstructive sleep apnea. The association was remarkable in the winter season.

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“…Our findings are consistent with those observed in clinical studies of the effects of CPAP treatment on catecholamines and blood pressure in patients with OSA, but the reduction in blood pressure is greater in this study (31 mmHg) compared with that in clinical studies (<10 mmHg). 27 , 28 There are a number factors that may contribute to this difference. In this study, phaeochromocytoma was excluded in all patients, therefore a good response to CPAP treatment would be expected.…”

Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure therapy reduces the levels of catecholamines and blood pressure in pseudophaeochromocytoma with coexisting obstructive sleep apnoea

Ken‐Dror

Wood

Fluck

et al. 2021

JRSM Cardiovascular Disease

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Background Stress from obstructive sleep apnoea (OSA) stimulates catecholamine release and consequently can exacerbate hypertension, even in the absence of a catecholamine-producing tumour (phaeochromocytoma). As such, a positive screening test for suspected phaeochromocytoma may be misleading. There exists only a handful case reports, and no controlled trials, how continuous positive airway pressure (CPAP) to treat OSA influences catecholamine levels. We examined changes to levels of urinary catecholamine and blood pressure in response to CPAP treatment. Methods We conducted a meta-analysis of data aggregated from published case reports of individual patient data up to April 2020. The quality of the reports was evaluated using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. Results A total of 13 cases (seven men and six women) from seven reports met our search criteria. Patients had mean age of 49.1 years (range = 36–62) and body mass index of 37.4 kg/m2 (range = 27–56). Most had moderate to severe OSA with CPAP treatment. Nine cases had 24-hour urinary noradrenaline assessment before and after CPAP treatment. CPAP treatment led to a 21% reduction (104 nmol/24-hours, 95% credible interval =59 to 148) in 24-hour urinary noradrenaline to within reference ranges, and 25% reduction (from 131 to 100 mmHg) in mean arterial pressure. The risk of overall bias evaluated by the ROBINS-I tool was found to be low in the majority of reports. Conclusions Investigations of patients suspected of phaeochromocytoma, particularly obese individuals, should exclude OSA and treat this condition if present before performing screening tests to assess for catecholamine levels.

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Meta‐analysis of changes in the levels of catecholamines and blood pressure with continuous positive airway pressure therapy in obstructive sleep apnea

Cited by 12 publications

References 59 publications

Changes in cortisol levels by continuous positive airway pressure in patients with obstructive sleep apnoea: Meta‐analysis of 637 individuals

Changes in cortisol levels by continuous positive airway pressure in patients with obstructive sleep apnoea: Meta‐analysis of 637 individuals

Association of Night‐to‐Night Adherence of Continuous Positive Airway Pressure With Day‐to‐Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea

Continuous positive airway pressure therapy reduces the levels of catecholamines and blood pressure in pseudophaeochromocytoma with coexisting obstructive sleep apnoea

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