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Volume 10 No. 04
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Scientific Investigations

Blood Pressure Improvement with Continuous Positive Airway Pressure is Independent of Obstructive Sleep Apnea Severity

http://dx.doi.org/10.5664/jcsm.3604

Jessie P. Bakker, Ph.D.1; Bradley A. Edwards, Ph.D.1; Shiva P. Gautam2; Sydney B. Montesi, M.D.3; Joaquín Durán-Cantolla, M.D., Ph.D.4; Felipe Aizpuru, M.D.4; Ferran Barbé, M.D., Ph.D.5; Manuel Sánchez-de-la-Torre, Ph.D.5; Atul Malhotra, M.D., F.A.A.S.M.1,3
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

Study Objectives:

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).

Design:

Patient-level meta-analysis.

Setting:

N/A.

Participants:

968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials.

Interventions:

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).

Conclusions:

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.

Citation:

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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