Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea
Abstract
Methods
Study Selection
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Data Abstraction
Statistical Analysis
Results
Study | Total No. | Age | Male | BMI, kg/m2 | AHI, Events per h | Design* | Blinding | BP Measure† | Control‡ | CPAP, wk | Baseline | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
SBP, mm Hg | DBP, mm Hg | |||||||||||
Values presented are mean (SD) or percent. AHI indicates apnea-hypopnea index; SBP, systolic BP; DBP, diastolic BP. | ||||||||||||
*P represents a parallel study design, and C represents a crossover study design. | ||||||||||||
†BP measure is recorded as clinical measurement using manual cuff (Manual) or as 24-hour ambulatory monitoring (Amb). | ||||||||||||
‡Control groups used placebo pills (Pill), subtherapeutic or sham CPAP treatment (Sham), or usual care (UC). | ||||||||||||
Englemann et al18 | 13 | 51.0 (10.8) | 84.6 | 36.0 (9.4) | 49 (32.4) | C | Open | Amb | Pill | 3 | … | … |
Barbe et al12 | 54 | 53.0 (10.7) | 90.7 | 29.0 (3.8) | 55.4 (17.9) | P | Single | Amb | Sham | 6 | 124.6 (10.4) | 78.1 (7.5) |
Faccenda et al20 | 68 | 50.0 | 80.9 | 30.0 | 35.0 | C | Open | Amb | Pill | 4 | … | … |
Monasterio et al26 | 125 | 53.5 (9.0) | 85.7 | 29.4 (3.4) | 20.5 (6.0) | P | Open | Manual | UC | 24 | 128.8 (17.0) | 82.4 (11.5) |
Barnes et al13 | 28 | 45.5 (10.7) | 85.7 | 30.9 (4.9) | 12.9 (5.8) | C | Open | Amb | Pill | 8 | 130.3 (10.5) | 81.6 (7.5) |
Pepperell et al23 | 118 | 50.6 (10.1) | 100.0 | 35.0 (7.3) | … | P | Double | Amb | Sham | 4 | 133.7 (17.0) | 85.1 (8.8) |
Becker et al15 | 32 | 53.4 (8.6) | 90.6 | 33.4 (5.5) | 63.8 (22.3) | P | Double | Amb | Sham | 9 | 136.1 (15.3) | 82.3 (14.1) |
Kaneko et al22 | 24 | 55.6 (10.6) | 87.5 | 31.4 (7.5) | 41.2 (20.3) | P | Open | Manual | UC | 4 | 127.0 (22.6) | 61.0 (13.9) |
Barnes et al14 | 110 | 47.0 (9.4) | 79.8 | 31.1 (5.3) | 21.3 (13.6) | C | Open | Amb | Pill | 12 | 126.5 (10.5) | 76.3 (8.4) |
Coughlin et al17 | 25 | … | … | … | … | C | … | Amb | Sham | 6 | … | … |
Ip et al21 | 27 | 42.7 (8.9) | 100.0 | 29.4 (5.7) | 46.5 (14.8) | P | Open | Manual | UC | 4 | 122.5 (11.9) | 75.6 (11.9) |
Mansfield et al24 | 40 | 57.6 (8.7) | 95.0 | 33.4 (5.0) | 25.8 | P | Open | Manual | UC | 12 | … | … |
Arias et al29 | 21 | 51.0 (13.0) | 96.0 | 30.9 (4.0) | 44.1 (29.3) | C | Double | Amb | Sham | 12 | 122.2 (10.0) | 76.4 (5.7) |
Campos-Rodriguez et al16 | 68 | 56.7 (8.3) | 60.2 | 34.8 (5.9.) | 58.9 (23.2) | P | Double | Amb | Sham | 4 | 131.2 (14.7) | 78.0 (9.5) |
Mills et al25 | 33 | 48.3 (10.4) | 84.8 | 31.9 (6.3) | 63.1 | P | Single | Manual | Sham | 2 | 152.2 (20.7) | 83.4 (12.1) |
Robinson et al19 | 32 | 54.0 (8.0) | 88.5 | 33.2 (5.3) | 28.1 | C | Double | Amb | Sham | 4 | 143.0 (17.3) | 86.7 (11.1) |
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Outcome | Day | Night | ||||
---|---|---|---|---|---|---|
No. of Trials | Mean Net Change | 95% CI | No. of Trials | Mean Net Change | 95% CI | |
Mean net change between treatment and control groups. SBP indicates systolic BP; DBP, diastolic BP. | ||||||
*Three trials reporting nighttime MAP did not report either nighttime SBP or DBP and, thus, are not included in those analyses. | ||||||
SBP | 9 | −3.00 | −5.90 to 0.51 | 6 | −2.29 | −5.44 to 0.87 |
DBP | 9 | −1.60 | −3.45 to 0.25 | 7 | −1.01 | −2.98 to 0.97 |
MAP | 7 | −2.05 | −4.67 to 0.57 | 6 | −3.30* | −5.82 to −0.81 |
Subgroup | Mean Net Change in Blood Pressure | |||||
---|---|---|---|---|---|---|
SBP | DBP | |||||
No. of Studies | Mean Net Change | 95% CI | No. of Studies | Mean Net Change | 95% CI | |
Mean net change between treatment and control groups. SBP indicates systolic BP; DBP, diastolic BP; AHI, apnea-hypopnea index. Cut points of continuous variables were based on the median value among the studies included. | ||||||
AHI | ||||||
≥42.7 | 7 | −1.22 | −4.28 to 1.83 | 7 | −1.15 | −3.71 to 1.41 |
<42.7 | 6 | −2.01 | −4.65 to 0.64 | 6 | −1.38 | −2.78 to 0.03 |
SBP | ||||||
≥129.6 | 6 | −2.57 | −6.18 to 1.04 | 6 | −2.82 | −4.97 to −0.68 |
<129.6 | 6 | −2.16 | −5.51 to 1.20 | 6 | −0.72 | −2.26 to 0.82 |
DBP | ||||||
≥79.9 | 6 | −4.36 | −8.14 to −0.58 | 6 | −3.79 | −5.80 to −1.78 |
<79.9 | 6 | −0.57 | −2.93 to 1.80 | 6 | −0.10 | −1.58 to 1.39 |
BMI | ||||||
≥31.4 | 7 | −4.36 | −8.27 to −0.45 | 7 | −2.55 | −4.58 to −0.52 |
<31.4 | 7 | −1.08 | −2.86 to 0.70 | 7 | −0.94 | −2.22 to 0.34 |
Study design | ||||||
Parallel | 8 | −4.03 | −7.95 to −0.11 | 8 | −2.20 | −4.48 to 0.08 |
Crossover | 7 | −1.61 | −3.35 to 0.13 | 7 | −1.44 | −2.74 to −0.14 |
CPAP duration | ||||||
≥6 weeks | 7 | −2.82 | −5.76 to 0.12 | 7 | −2.16 | −4.51 to 0.19 |
<6 weeks | 8 | −2.09 | −4.50 to 0.31 | 8 | −1.78 | −3.40 to −0.15 |
Sample size | ||||||
≥32 | 9 | −2.49 | −4.87 to −0.11 | 9 | −1.81 | −3.34 to −0.27 |
<32 | 6 | −2.56 | −5.94 to 0.82 | 6 | −2.06 | −4.36 to 0.24 |
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Discussion
Perspectives
Acknowledgments
Footnote
References
Information & Authors
Information
Published In
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On the cover: Molecular mechanism of angiotensin receptor type-1 agonistic antibodies (AT1-AA)-mediated AT1 receptor activation. Multiple signaling pathways function downstream of AT1-AA-mediated AT1 receptor activation. AT1-AA-mediated AT1 receptor activation leads to increased protein kinase C (PKC) and calcineurin activity. As a result, downstream transcription factors, such as activating protein-1 (AP-1), nuclear factor κB (NF-κB), and nuclear factor activating T cell (NFAT), are activated and translocated from cytosol to nucleus, which leads to increased gene expression. Because AT1-activating autoantibodies are bivalent IgG protein complexes, their agonistic effect is proposed to be exerted by cross-linking and thereby stabilizing AT1 receptor homodimers. DAG indicates diacylglycerol; IP3, inositol triphosphate; PAI-1, plasminogen activating inhibitor-1; and TF, tissue factor. (See page 272.)
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- CPAP Therapy for OSA and Its Impact on Various Cardiovascular Disorders, Cardiology in Review, (2025).https://doi.org/10.1097/CRD.0000000000000843
- Recent Advances in Therapeutic Approach for Hypertension to Improve Cardiac Health, Hemodynamics of the Human Body, (2024).https://doi.org/10.5772/intechopen.111841
- JCS 2023 Guideline on Diagnosis and Treatment of Sleep Disordered Breathing in Cardiovascular Disease, Circulation Journal, 88, 11, (1865-1935), (2024).https://doi.org/10.1253/circj.CJ-23-0489
- Chapter 12. Obstructive Sleep Apnea, Handbook of Medicine in Psychiatry, Third Edition, (153-167), (2024).https://doi.org/10.1176/appi.books.9781615379330.lg12
- Chapter 9. Sleep-Related Breathing Disorders, Clinical Manual for Evaluation and Treatment of Sleep Disorders, (217-239), (2024).https://doi.org/10.1176/appi.books.9781615377787.lg09
- Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy, Hypertension Research, 47, 11, (3085-3098), (2024).https://doi.org/10.1038/s41440-024-01852-y
- Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea, Respiratory Investigation, 62, 4, (645-650), (2024).https://doi.org/10.1016/j.resinv.2024.05.004
- Obesity and Hypertension: Pathophysiology and Treatment, Hypertension, (413-426), (2024).https://doi.org/10.1016/B978-0-323-88369-6.00037-2
- CPAP-Beatmung: auch Effekte auf den erhöhten Blutdruck, Pneumo News, 16, 3, (17-19), (2024).https://doi.org/10.1007/s15033-024-4015-9
- Schlafbezogene Atmungsstörungen: Obstruktive und zentrale Schlafapnoe, DGIM Innere Medizin, (1-16), (2024).https://doi.org/10.1007/978-3-642-54676-1_397-2
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