Abstract
The treatment for obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) is associated with blood pressure (BP) reduction however, the overall effect is modest. The aim of this systematic review and meta-analysis of RCTs comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.
The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MAD with either passive or active treatment. When all the studies are pooled together, CPAP and MAD are associated with an average BP reduction of −2.09 (−2.78, −1.40) mmHg [mean (95%CI)] for the systolic and of −1.92 (−2.40, −1.43) mmHg for the diastolic BP, and of −1.27 (−2.34, −0.20) mmHg for systolic and of −1.11 (−1.82, −0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those: younger than 60 years (systolic BP −2.93 mmHg), with uncontrolled BP at baseline (systolic BP −4.14 mmHg) and with severe oxygen desaturations (SpO2-nadir<77%) at baseline (24 h systolic BP −7.57 mmHg).
Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of blood pressure control. These findings should be interpreted with caution, however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr pengo has nothing to disclose.
Conflict of interest: Dr Soranna has nothing to disclose.
Conflict of interest: Dr Giontella has nothing to disclose.
Conflict of interest: Dr Perger has nothing to disclose.
Conflict of interest: Dr mattaliano has nothing to disclose.
Conflict of interest: Dr Schwarz has nothing to disclose.
Conflict of interest: Dr Lombardi has nothing to disclose.
Conflict of interest: Dr Bilo has nothing to disclose.
Conflict of interest: Dr Zambon has nothing to disclose.
Conflict of interest: Dr Parati has nothing to disclose.
Conflict of interest: Dr Minuz has nothing to disclose.
Conflict of interest: Dr FAVA has nothing to disclose.
Conflict of interest: Dr Steier has nothing to disclose.
- Received October 2, 2019.
- Accepted February 6, 2020.
- Copyright ©ERS 2020
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