Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis.
Martino F PengoDavide SorannaAlice GiontellaElisa PergerPaola MattalianoEsther Irene SchwarzCarolina LombardiGrzegorz BiloAntonella ZambonJoerg SteierGianfranco ParatiPietro MinuzCristiano FavaPublished in: The European respiratory journal (2020)
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.
Keyphrases
- blood pressure
- positive airway pressure
- obstructive sleep apnea
- systematic review
- left ventricular
- sleep apnea
- heart failure
- hypertensive patients
- heart rate
- meta analyses
- clinical trial
- depressive symptoms
- randomized controlled trial
- machine learning
- adipose tissue
- type diabetes
- climate change
- sleep quality
- combination therapy
- genome wide
- skeletal muscle
- transcription factor
- blood glucose
- weight loss
- case control