Effect of different treatments for obstructive sleep apnoea on blood pressure

Abstract

Objective: Obstructive sleep apnoea (OSA) is a common cause of secondary hypertension. This network metaanalysis (NMA) assessed the effect of different OSA treatments on lowering blood pressure.Methods: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for relevant randomized controlled trials. The search strategies included the concepts of OSA, blood pressure, hypertension, and blood pressure-reducing treatments without language or data restriction (from inception to 1 June 2021). The outcomes included office SBP, office DBP, daytime SBP (dSBP) and DBP (dDBP), and night-time SBP (nSBP) and DBP (nDBP). A Bayesian network meta-analysis was performed, and mean differences with 95% credibility intervals were calculated.Results: We reviewed 49 randomized controlled trials involving 4893 patients and the following interventions: continuous positive-airway pressure (CPAP), mandibular advancement devices, nocturnal supplemental oxygen, surgery, b-blocker, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), renal sympathetic denervation (RDN), mineralocorticoid receptor antagonists (MRAs), calcium channel blockers. MRAs were significantly associated with blood pressure reduction followed by ACEI/ARB. RDN could reduce office SBP, office DBP, 24-h SBP, 24-h DBP, dSBP, and dDBP. CPAP also demonstrated modest blood pressure lowering. Conclusion:MRAs and ACEIs/ARBs can reduce blood pressure effectively in patients with OSA. RDN is a novel hypertension treatment that lowered blood pressure in such patients. CPAP was associated with mild but stable blood pressure reduction, and it might be helpful as an adjunctive therapy in OSA patients with hypertension.Review registration: This systematic review and metaanalysis was registered in PROSPERO: CRD42021240891.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…To reduce BP in patients with OSA, all major classes of antihypertensive drugs can be used. BP reduction has been reported also with the use of MRAs [1495]. Continuous positive airway pressure (CPAP) application has been shown to induce small reductions (about 3 mmHg for) in office and 24 h SBP, the 24 h BP reduction including day-time and night-time BP values [1496].…”

Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication

“…Improvement of 24-h BPs was slightly higher, SBP −3.13 (−5.10 to −1.66) and DBP −2.88 (−4.46 to −1.55) mmHg. 13 Improvement of daytime SBP and DBP (6 a.m. to 10 p.m.) varied between −2.27 to −2.7 and −1.78 to −2.4 in previous meta-analyses. 41–43 These BP reductions observed in controlled trials are comparable with the changes in office BP observed in our large clinical real-life OSA patient cohort where PAP use with high adherence was associated with a SBP and DBP reduction of approximately 3–4 mmHg in unadjusted analysis.…”

“… 12 Positive airway pressure (PAP) treatment of OSA can effectively eliminate the immediate consequences of repetitive apnoeas and can reduce office blood pressure (BP), but only by a modest mean reduction of 2–3 mmHg. 13 This highlights the need for optimized antihypertensive medication in these patients even when treated successfully for OSA with PAP. Indeed, several studies suggest that BP control is particularly poor in hypertensive patients with OSA.…”

Nocturnal oxygen therapy in obstructive sleep apnoea: a systematic review and meta-analysis

“…The current gold standard treatment for OSA is CPAP therapy. CPAP is effective in abolishing intermittent hypoxia secondary to upper airway collapse, and has been shown to reduce AHI and arousals and improve blood pressure [ 23 , 24 ]. The main limiting factor for CPAP treatment is poor tolerance; CPAP nonadherence rates have been consistently as high as 34% despite advances in machine dynamics and behavioural interventions [ 25 ].…”