Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis. Issue 5 (7th May 2020)

• Record Type: Journal Article
• Authors: Pengo, Martino F.; Soranna, Davide; Giontella, Alice; Perger, Elisa; Mattaliano, Paola; Schwarz, Esther Irene; Lombardi, Carolina; Bilo, Grzegorz; Zambon, Antonella; Steier, Joerg; Parati, Gianfranco; Minuz, Pietro; Fava, Cristiano
• Is Part Of: European respiratory journal. Volume 55:Issue 5(2020)
• Publication Date: 2020-05-07
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01945-2019
• Languages: English
• ISSNs: 0903-1936

Abstract

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. This study identified age, blood pressure levels before treatment and hypoxic burden expressed by the minimum desaturation as potential predictors of blood pressure reduction in patients treated for obstructive sleep apnoea http://bit.ly/31LdrJA