TY - JOUR
T1 - Obstructive sleep apnoea treatment and blood pressure
T2 - Which phenotypes predict a response? A systematic review and meta-analysis
AU - Pengo, Martino F.
AU - Soranna, Davide
AU - Giontella, Alice
AU - Perger, Elisa
AU - Mattaliano, Paola
AU - Schwarz, Esther Irene
AU - Lombardi, Carolina
AU - Bilo, Grzegorz
AU - Zambon, Antonella
AU - Steier, Joerg
AU - Parati, Gianfranco
AU - Minuz, Pietro
AU - Fava, Cristiano
N1 - Publisher Copyright:
© ERS 2020.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (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 MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of 2.09 (95% CI 2.78-1.40) mmHg for systolic BP and 1.92 (95% CI 2.40-1.43) mmHg for diastolic BP and 1.27 (95% CI 2.34-0.20) mmHg for systolic BP and 1.11 (95% CI 1.82-0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP 2.93 mmHg), with uncontrolled BP at baseline (systolic BP 4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <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 BP 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.
AB - The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (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 MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of 2.09 (95% CI 2.78-1.40) mmHg for systolic BP and 1.92 (95% CI 2.40-1.43) mmHg for diastolic BP and 1.27 (95% CI 2.34-0.20) mmHg for systolic BP and 1.11 (95% CI 1.82-0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP 2.93 mmHg), with uncontrolled BP at baseline (systolic BP 4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <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 BP 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.
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U2 - 10.1183/13993003.01945-2019
DO - 10.1183/13993003.01945-2019
M3 - Review article
C2 - 32079643
AN - SCOPUS:85084379713
VL - 55
JO - European Respiratory Journal
JF - European Respiratory Journal
SN - 0903-1936
IS - 5
M1 - e1901945
ER -