Effect of long-term continuous positive airway pressure ventilation on blood pressure in patients with obstructive sleep apnea hypopnea syndrome: A meta-analysis of clinical trials
ABSTRACT To explore whether long-term continuous positive airway pressure (CPAP) ventilation is effective to decrease the blood pressure in the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) accompanied with hypertension.
Literatures of relevant randomized, controlled, prospective, clinical trials 2000 - 2006 in English and Chinese were retrieved from Medline and CNKI based on the criteria: the subjects being patients with OSAHS, the study lasting at least 4 weeks, and the effect on 24 hours ambulatory blood pressure in CPAP group being compared with that in no-CPAP group. The data thus collected underwent meta-analysis.
471 cases in 7 studies were included. Three of the 7 studies indicated that CPAP ventilation could decrease the diastolic blood pressure in the patients with OSAHS and four studies showed no significant difference in the effect of CPAP on blood pressure between the two groups. From meta-analysis, the weighted mean difference (WMD) in fixed effect model of 24 h diastolic blood pressure (DBP) was -1.78 [95% CI: -3.34, -0.22]; the WMD (fixed) of 24 h systolic blood pressure (SBP) was -0.95 [95% CI: -2.85, 0.94], and the WMD (random) of 24 h mean blood pressure (MBP) was -1.25 [95% CI: -4.00, 1.49].
The long-term CPAP ventilation can decrease the 24 h DBP.
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ABSTRACT: Obstructive sleep apnea/hypopnea (OSAH) syndrome is a highly prevalent condition. Severe OSAH affects 2-6% of the population, although only 10% of subjects are correctly diagnosed and treated. OSAH is an important and unresolved public health care problem because of its role in the development of cardiovascular events, negative impact on quality of life, and as a cause of traffic accidents. Longitudinal and cross-sectional studies have shown a strong association between OSAH and hypertension. Moreover, a number of open-label studies, the majority of 21 controlled studies included in the present review, a systematic review, and 4 recent meta-analyses have shown a reduction of blood pressure (BP) of about 2 mm Hg with continuous positive airway pressure (CPAP). This lowering of blood pressure is significant in terms of reduction of both cardiovascular and cerebrovascular risk and death. The effect is greater in hypertensive subjects and in those with more severe OSAH. Accordingly, treatment with CPAP could be considered in patients with severe OSAH and hypertension even in the absence of symptoms. The challenge to researchers is to find markers for discriminating subjects in whom blood pressure will decrease from non-responders. This will help to refine relevant clinical indicators for CPAP treatment in clinical practice.Sleep Medicine Reviews 07/2009; 13(5):323-31. DOI:10.1016/j.smrv.2008.11.001 · 9.14 Impact Factor
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ABSTRACT: Obstructive sleep apnea (OSA) and hypertension commonly coexist. Observational studies indicate that untreated OSA is associated with an increased risk of prevalent hypertension, whereas prospective studies of normotensive cohorts suggest that OSA may increase the risk of incident hypertension. Randomized evaluations of continuous positive airway pressure (CPAP) indicate an overall modest effect on blood pressure. However, these studies do indicate a wide variation in the blood pressure effects of CPAP, with some patients, on an individual basis, manifesting a large antihypertensive benefit. OSA is particularly common in patients with resistant hypertension. The reason for this high prevalence of OSA is not fully explained, but data from our laboratory suggest that it may be related to the high occurrence of hyperaldosteronism in patients with resistant hypertension. We hypothesize that aldosterone excess worsens OSA by promoting accumulation of fluid in the neck, which then contributes to increased upper airway resistance.Current Hypertension Reports 06/2010; 12(3):189-95. DOI:10.1007/s11906-010-0112-8 · 3.90 Impact Factor
Article: Sleep and Hypertension[Show abstract] [Hide abstract]
ABSTRACT: Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.Chest 08/2010; 138(2):434-43. DOI:10.1378/chest.09-2954 · 7.13 Impact Factor