Blood Pressure Improvement with Continuous Positive Airway Pressure is Independent of Obstructive Sleep Apnea Severity
1Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA; 2Division of Translational Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA; 3Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston MA; 4Research Department, Sleep Division, Araba University, Basque Country University, Vitoria Spain; 5Hospital Arnau de Vilanova, IRB Lleida, Respiratory Department, Lleida, Spain. CIBERes, Madrid, Spain
We sought to perform a patient-level meta-analysis using the individual patient data of the trials identified in our previous study-level meta-analysis investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP).
968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials.
Therapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week.
Measurements and Results:
The mean reductions in BP between PAP and non-therapeutic control arms were -2.27 mm Hg (95% CI -4.01 to -0.54) for systolic BP and -1.78 mm Hg (95% CI -2.99 to -0.58) for diastolic BP. The presence of uncontrolled hypertension at baseline was significantly associated with a reduction in systolic BP of 7.1 mm Hg and diastolic BP of 4.3 mm Hg after controlling for OSA severity (apnea-hypopnea index, Epworth Sleepiness Scale score, PAP level), patient demographics (age, gender, body mass index, use of antihypertensive medication/s), and measures of PAP efficacy (PAP adherence and treatment duration).
OSA patients with uncontrolled hypertension are likely to gain the largest benefit from PAP in terms of a substantial reduction in BP, even after controlling for disease severity.
Bakker JP; Edwards BA; Gautam SP; Montesi SB; Durán-Cantolla J; Aizpuru F; Barbé F; Sánchezde-la-Torre M; Malhotra A. Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity. J Clin Sleep Med 2014;10(4):365-369.
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