Chest
Volume 145, Issue 4, April 2014, Pages 762-771
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Original Research: Sleep Disorders
Effect of CPAP on Blood Pressure in Patients With OSA/Hypopnea: A Systematic Review and Meta-analysis

https://doi.org/10.1378/chest.13-1115Get rights and content

Background

CPAP is considered the therapy of choice for OSA, but the extent to which it can reduce BP is still under debate. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to quantify the effect size of the reduction of BP by CPAP therapy compared with other passive (sham CPAP, tablets of placebo drug, conservative measures) or active (oral appliance, antihypertensive drugs) treatments.

Methods

We searched four different databases (MEDLINE, EMBASE, Web of Science, and the Cochrane Library) with specific search terms and selection criteria.

Results

From 1,599 articles, we included 31 RCTs that compared CPAP with either passive or active treatment. In a random-effects meta-analysis vs passive treatment (29 RCTs, 1,820 subjects), we observed a mean ± SEM net difference in systolic BP of 2.6 ± 0.6 mm Hg and in diastolic BP of 2.0 ± 0.4 mm Hg, favoring treatment with CPAP (P < .001). Among studies using 24-h ambulatory BP monitoring that presented data on daytime and nighttime periods, the mean difference in systolic and diastolic BP was, respectively, 2.2 ± 0.7 and 1.9 ± 0.6 mm Hg during daytime and 3.8 ± 0.8 and 1.8 ± 0.6 mm Hg during nighttime. In meta-regression analysis, a higher baseline apnea/hypopnea index was associated with a greater mean net decrease in systolic BP (β ± SE, 0.08 ± 0.04). There was no evidence of publication bias, and heterogeneity was mild (I2, 34%-36%).

Conclusions

Therapy with CPAP significantly reduces BP in patients with OSA but with a low effect size. Patients with frequent apneic episodes may benefit the most from CPAP.

Section snippets

Materials and Methods

An extended version of the Materials and Methods section is presented in e-Appendix 1. The systematic review and meta-analysis adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting on systematic reviews.14 We conducted the meta-analysis in accordance with the general guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.14, 15

Study Selection

From a total of 1,599 reports in the initial search, we identified 31 studies11, 12, 13, 16, 17, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 that met the inclusion criteria and included these in the systematic review, with 29 being included in the main meta-analysis (n = 1,820) (Fig 1).12, 13, 16, 17, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 42, 43, 44, 45, 46, 47, 48, 49 The κ statistic indicated a strong

Discussion

The results of the present meta-analysis indicate that CPAP is associated with a significant reduction in both systolic and diastolic BP with respect to passive treatment with a low to moderate effect size. Because most of the included primary studies showed either a low or very-low quality, these results should be regarded with caution. However, when analyzing only the intermediate-to high-quality studies, the results are strengthened, and there is a tendency toward a more marked BP lowering

Acknowledgments

Author contributions: Dr Fava had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Fava: contributed to the study design, literature search, data extraction, statistical analysis, and drafting of the manuscript.

Dr Dorigoni: contributed to the study design, retrieval of studies, data extraction from the original articles, statistical analysis, and drafting of the manuscript.

Dr Dalle Vedove: contributed to

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  • Cited by (0)

    Drs Dorigoni and Dalle Vedove contributed equally to this work.

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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