Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials

Lei, Qiang; Lv, Yunhui; Li, Kai; Ma, Lei; Du, Guodong; Xiang, Yan; Li, Xuqing

doi:10.1590/s1806-37562016000000190

Cited by 38 publications

(22 citation statements)

References 32 publications

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“…OSAHS is a potential major risk factor for the morbidity and mortality of many cardiovascular complications 2 , such as hypertension, arrhythmias, myocardial infarction, heart failure, ventricular hypertrophy, systolic and diastolic dysfunctions, as well as stroke 3,4 . OSAHS is associated with a significantly higher risk of hypertension and is regarded as an independent risk factor for hypertension 5 . Evidence indicated that the cardiac dysfunction and cardiomyocyte injury was detected in OSAHS patients and animal modes 6,7 .…”

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confidence: 99%

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Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Liu

Kang

Zhang

et al. 2020

Sci Rep

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Although considerable research highlights the interactions between obstructive sleep apnea-hypopnea syndrome (OSAHS) and cardiovascular diseases, the effect of mandibular advancement device (MAD) treatment on cardiovascular complications in OSAHS patients remains unclear. We evaluated the effect of OSAHS treatment with MADs on the myocardium. All methods in this study were in accordance with relevant guidelines and regulations of the medical ethics committee in Hospital of Stomatology, Hebei Medical University approved the work. Thirty New Zealand rabbits were randomized into three groups: the control group, Group OSAHS, and Group MAD. Hydrophilic polyacrylamide gel was injected into the soft palate of the rabbits to induce OSAHS. In Group MAD, a MAD was positioned after OSAHS induction. All animals were induced to sleep in a supine position for 4-6 h/day for 8 weeks. Echocardiography was used to determine the structure and function of the heart. The histological changes were detected by optical microscopy and transmission electron microscopy (TEM). The levels of ET-1(endothelin-1) and Ang II (Angiotensin II) in the plasma were measured by an enzyme-linked immunosorbent assay (ELISA). The expression of ET-1 mRNA in heart tissue was detected by RT-PCR. Histological abnormalities, left ventricular hypertrophy, and left ventricular dysfunctions were demonstrated in Group OSAHS, and the abnormities were rescued with MAD treatment. Higher levels of plasma ET-1 and Ang II and elevated expression of ET-1 mRNA in cardiac tissue were detected in Group OSAHS compared with Group MAD and the control group. The blood oxygen saturation was negatively correlated with the levels of ET-1 and Ang II. OSAHS-induced elevated levels of ET-1 and Ang II may be attributed to myocardial structural abnormalities and dysfunction. Early treatment of MADs may play an important role in preventing myocardial damage in OSAHS rabbit model.

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confidence: 99%

“…It has been shown that OSAHS treatment might reduce the risk of cardiovascular complications. CPAP treatment has been proven to reduce blood pressure 5,20 and correct left ventricular hypertrophy and systolic and diastolic dysfunctions caused by OSAHS 21,22 . There were limited data on the effects of oral appliance treatment on cardiac function.…”

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confidence: 99%

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Liu

Kang

Zhang

et al. 2020

Sci Rep

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“…Treatment of OSA with continuous positive airway pressure (CPAP) therapy has shown beneficial effects in patients with cardiovascular disorders (Maeder, Schoch, & Rickli, 2016). CPAP treatment decreases blood pressure in patients with resistant hypertension (Lei et al, 2017) and improves heart function in patients with heart failure (Sun, Shi, Li, & Chen, 2013). There is evidence that CPAP treatment decreases the activity of the sympathetic nervous system (Fatouleh et al, 2015) and oxidative stress (Tichanon et al, 2016), which play a crucial rule in the development of arrhythmia in patients with OSA (Bitter, Fox, Gaddam, Horstkotte, & Oldenburg, 2015).…”

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confidence: 99%

The STOP‐BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation

Abumuamar

Dorian

Newman

et al. 2018

Journal of Sleep Research

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Obstructive sleep apnea (OSA) is a sleep disorder associated with significant cardiovascular comorbidities, including cardiac arrhythmia. The STOP-BANG questionnaire is an eight-item self-report questionnaire designed to screen patients for OSA and was validated in preoperative surgical patients. The STOP items are snoring, daytime tiredness, observed apneas and high blood pressure. The BANG items are body mass index >35 kg/m , age >50 years, neck circumference >40 cm and male gender. We aimed to determine the screening properties of the STOP-BANG questionnaire in patients with arrhythmia. Non-selected consecutive patients were recruited from arrhythmia clinics. Patients with previously diagnosed and/or treated OSA were excluded. The STOP-BANG questionnaire was self-administered. Patients underwent two consecutive nights of home sleep recording. OSA was defined as an apnea-hypopnea index score of ≥5/hr of sleep. The screening properties of the STOP-BANG questionnaire were analysed compared with the objective diagnosis of OSA by ambulatory testing. Ninety-five patients were included in the final analysis. Eighty-five percent were found to have OSA. The STOP-BANG score of ≥3 was 89% sensitive and 36% specific for diagnosis of OSA. The STOP-BANG questionnaire had fair performance, as indicated by an area under the curve of 0.74 (p = .004). In conclusion, the STOP-BANG questionnaire is sensitive; however, it has a low specificity with a high false positive rate. Given that a large number of atrial fibrillation patients need testing for OSA, we recommend the use of a level II sleep study regardless of the results of the screening questionnaire. This approach accurately identifies OSA and may limit the cost of unnecessary level-I sleep studies.

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“…A meta-analysis of randomized controlled trials indicated reductions in mean systolic blood pressure of 5.4 mm Hg and diastolic blood pressure of 3.86 mm Hg after CPAP in those with resistant hypertension and OSA. 58 Weight loss has been shown to reduce the AHI and other parameters related to sleep apnea such as oxygen desaturation index in patients with obesity and diabetes. 59 Weight loss combined with CPAP compared with CPAP or weight loss alone showed an incremental benefi t in improving glucose parameters, triglycerides, and possibly systolic blood pressure and triglycerides.…”

Section: Effect Of Treatment For Osa On Metabolic Syndromementioning

confidence: 99%

Beyond heart health: Consequences of obstructive sleep apnea

Walia

2019

CCJM

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Obstructive sleep apnea (OSA) is a serious condition associated with impaired quality of life, depression, drowsy driving and motor vehicle accidents, metabolic disease, and cognitive decline. The mechanisms accounting for OSA and metabolic disease include hypoxia, sleep fragmentation, and systemic infl ammation. OSA appears to advance cognitive decline, and the relationship between the 2 conditions may be bidirectional. Treatment of patients with continuous positive air pressure therapy improves many of the impaired outcomes associated with OSA. Greater awareness, screening, and treatment of patients with OSA can reduce the negative consequences associated with OSA.

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Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials

Cited by 38 publications

References 32 publications

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

The STOP‐BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation

Beyond heart health: Consequences of obstructive sleep apnea

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