CPAP therapy reduces blood pressure for patients with obstructive sleep apnoea: an update meta-analysis of randomized clinical trials

Sun, Yu; Huang, Ziyang; Sun, Qing-Rong; Qiu, Li-Ping; Zhou, Tingting; Zhou, Guihua

doi:10.1080/ac.71.3.3152087

Cited by 14 publications

(15 citation statements)

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“…Our other hypothesis was that the severity of SDB is associated with carbohydrate metabolism abnormalities, but our study revealed no significant relationship between REM-or non-REM-related AHI 42,43 In the pediatric population, the first-line treatment of SDB is AT, whereas CPAP is considered as second-line therapy. 20 The effect of AT on the BP and carbohydrate parameters is still unclear.…”

Section: Discussioncontrasting

confidence: 57%

“…Based on pediatric and adult studies, SDB seems to be a frequent, chronic condition in the RTx population, and it might contribute to the development of high BP and glycemic abnormalities. With the early diagnosis and treatment of SDB and other components of MetS, their potential unfavorable effect on CKD could be ameliorated . In the pediatric population, the first‐line treatment of SDB is AT, whereas CPAP is considered as second‐line therapy .…”

Section: Discussionmentioning

confidence: 99%

“…44 However, the clinical impact of SDB might be different in patients with comorbidities. 45 Among adult patients, there is evidence that the treatment of SDB resulted in improvement of HTN 42 and glycemic control. 43 Despite using objective measurements for the assessment of SDB, the major limitation of our study arises from the small sample size.…”

Section: Discussionmentioning

confidence: 99%

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Cardiometabolic correlates of sleep‐disordered breathing in renal transplant children

Lendvai

Pásti

Szeifert

et al. 2019

Pediatric Transplantation

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Sleep‐disordered breathing, a prevalent condition among adult renal transplant (RTx) recipients, has become an established independent risk factor of MetS, and furthermore, it might contribute to increased CV risk. Despite the proven correlations in adults, there is a lack of evidence for its significance in the pediatric RTx population. In this study, we aimed at assessing the prevalence and the clinical correlates of SDB in RTx children. Data of 13 patients (age [mean ± SD]: 14.2 ± 2.7 years) were analyzed. SDB was evaluated by PSG, as severity score OAHI was applied. Carbohydrate metabolism was characterized by OGTT, whereas CV status was studied by ABPM. Three composite end‐points were calculated as sum of z‐scores: daytime systolic and diastolic BP; nighttime systolic and diastolic BP; and glucose and insulin levels at 120 minutes. Eight patients (61.5%) were diagnosed with SDB of whom five patients (38.5%) had moderate or severe SDB. In linear regression analysis, OAHI during REM was associated with the CV variables (daytime BP P = 0.032, ß = 0.748; nighttime BP P = 0.041, ß = 0.715), and the correlations remained significant after adjustments for BMI. However, we did not confirm a significant association with the metabolic variables. The prevalence of SDB was high, and its severity during REM was a predictor of the BP suggesting that RTx children with SDB might be at risk of developing CV complications, especially HTN similarly to adults.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiometabolic correlates of sleep‐disordered breathing in renal transplant children

Lendvai

Pásti

Szeifert

et al. 2019

Pediatric Transplantation

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“…Six weeks of treatment with losartan and allopurinol lowered arterial pressure in hypertensive patients with moderate‐to‐severe OSA who were, on average, adherent to CPAP treatment. The effects of CPAP alone on arterial pressure are variable (Becker et al., ; Campos‐Rodriguez et al., ; Robinson et al., ) and, at best, modest (Hu, Fan, Chen, Yin, & Zrenner, ; Sun et al., ). Optimal blood pressure control in OSA often requires additional pharmacotherapy; however, no specific class of antihypertensive agents has been judged to be superior (Ahmad, Makati, & Akbar, ).…”

Section: Discussionmentioning

confidence: 99%

Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Morgan

Teodorescu

Pegelow

et al. 2018

Experimental Physiology

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Chemoreflex sensitization produced by chronic intermittent hypoxia in rats is attenuated by angiotensin II type 1 receptor (AT R) blockade. Both AT R blockade and xanthine oxidase inhibition ameliorate chronic intermittent hypoxia-induced endothelial dysfunction. We hypothesized that treatment with losartan and allopurinol would reduce chemoreflex sensitivity and improve hypoxic vasodilatation in patients with obstructive sleep apnoea. Eighty-six hypertensive patients with apnoea-hypopnoea index ≥25 events h and no other cardiovascular, pulmonary, renal or metabolic disease were randomly assigned to receive allopurinol, losartan or placebo for 6 weeks. Treatment with other medications and/or continuous positive airway pressure remained unchanged. Tests of chemoreflex sensitivity and hypoxic vasodilatation were performed during wakefulness before and after treatment. Ventilation (pneumotachography), muscle sympathetic nerve activity (microneurography), heart rate (electrocardiography), arterial oxygen saturation (pulse oximetry), blood pressure (sphygmomanometry), forearm blood flow (venous occlusion plethysmography) and cerebral flow velocity (transcranial Doppler ultrasound) were measured during eupnoeic breathing and graded reductions in inspired O tension. Losartan and allopurinol lowered arterial pressure measured during eupnoeic breathing and exposure to acute hypoxia. Neither drug altered the slopes of ventilatory, sympathetic or cardiovascular responses to acute hypoxia. We conclude that losartan and allopurinol are viable pharmacotherapeutic adjuncts for achieving blood pressure control in hypertensive obstructive sleep apnoea patients, even those who are adequately treated with continuous positive airway pressure.

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“…Several meta-analyses were published in the last decade on randomised controlled trials (RCT) assessing the effects of CPAP on blood pressure (BP). There are methodological differences, as some meta-analyses (n = 7) analysed studies reporting office BP and/or nocturnal and diurnal values obtained by ambulatory blood pressure monitoring (ABPM) [8][9][10][11][12][13][14] , while others (n = 2) only considered ABPM studies 15,16 . Three studies examined the effects of CPAP in OSA patients with resistant hypertension [17][18][19] .…”

Section: Effects Of Continuous Positive Airway Pressure On Systemic Bmentioning

confidence: 99%

Beneficial Effects of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnoea: The Evidence

Bonsignore¹,

Marrone²,

McNicholas³

2017

BRN

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CPAP therapy reduces blood pressure for patients with obstructive sleep apnoea: an update meta-analysis of randomized clinical trials

Cited by 14 publications

References 0 publications

Cardiometabolic correlates of sleep‐disordered breathing in renal transplant children

Cardiometabolic correlates of sleep‐disordered breathing in renal transplant children

Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Beneficial Effects of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnoea: The Evidence

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