Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Ning, Yu; Zhang, Tiansong; Wen, Wanwan; Li, Kun; Yang, Yunxiao; Qin, Yanwen; Zhang, Huina; Du, Yunhui; Li, Linyi; Yang, Song; Zhu, Miaomiao; Jiao, Xiaolu; Zhang, Yan; Zhang, Ming; Wei, Yongxiang

doi:10.1007/s11325-018-1662-2

Cited by 45 publications

(40 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, our results cannot be directly compared to these previous RCTs because we enrolled only patients with RHT, a specific subgroup of the general hypertensive population with an a priori expected increased aortic stiffness and, hence, possibly a greater effect of CPAP on reducing it. Notwithstanding, we observed a very similar effect of CPAP on cf‐PWV (−0.40 m/s, 95% CI −0.82 to +0.02 m/s; p = .059) to the pooled meta‐analytic results previously noted (Ning et al, ). Most important, this effect was mainly due to preventing aortic stiffness worsening in the CPAP group, in contrast to the control group.…”

Section: Discussionsupporting

confidence: 89%

“…The mechanical properties of the arterial wall have a rather fixed, irreversible component determined by its load-bearing components, namely its elastin and collagen contents and to a lesser extent the matrix constituents, and also a dynamic component determined by vascular smooth muscle tone, which mainly depends on endothelium-dependent and independent factors, systemic and vascular inflammation, and the autonomic nervous system activity, as well as on the distending pressure itself (Phillips, Butlin, et al, 2013). We can speculate that patients with RHT, because of the long-standing bur- to arterial stiffness progression (Ning et al, 2019;Pépin, Tamisier, Baguet, & Lévy, 2013;Phillips, Butlin, et al, 2013;Ryan, 2013). These aspects might explain the somewhat modest effects of CPAP treatment on aortic stiffness in RHT patients observed in the present RCT, mainly limited to preventing its worsening, in contrast to the control group.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, the effect of CPAP on aortic stiffness in hypertensive patients is still largely unknown from adequately performed RCTs. Four of these previous studies (Drager et al, ; Jones et al, ; Litvin et al, ; Paz y Mar et al, ) were recently meta‐analysed (Ning et al, ), with an estimated pooled mean difference in cf‐PWV change between CPAP and control groups of −0.46 m/s (95% CI, −0.93 to +0.01; p = .058). Our study is one of the largest and longest RCTs evaluating the effects of CPAP on aortic stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…Arterial stiffness, especially central aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV), is a potent cardiovascular risk marker in several clinical settings (Ben-Shlomo et al, 2014), including in RHT (Cardoso, Salles, & Salles, 2019). Otherwise, although some previous non-randomized observational studies suggested that CPAP treatment might reduce aortic stiffness (Buchner et al, 2012;Kartali et al, 2014;Mineiro et al, 2017), few randomized controlled trials (RCTs) evaluated this hypothesis, with controversial findings (Drager, Bortolotto, Figueiredo, Krieger, & Lorenzi, 2007;Jain et al, 2017;Jones et al, 2013;Litvin et al, 2013;Ning et al, 2019;Paz y Mar et al, 2016), and none of them were in RHT patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial

Cardoso

Roderjan

Cavalcanti

et al. 2020

Journal of Sleep Research

View full text Add to dashboard Cite

Resistant hypertension (RHT) is associated with obstructive sleep apnea (OSA) and increased aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV). We aimed to evaluate in a randomized controlled trial, the effect of Continuous positive airway pressure (CPAP) treatment on cf-PWV in comparison with a control group in patients with RHT and moderate-severe OSA. One-hundred and sixteen patients were randomized to 6-month CPAP treatment (56 patients) or no therapy (60 patients), while keeping their antihypertensive treatment unchanged. Carotid-femoral pulse wave velocity was performed at the beginning and end of the 6-month period. Intention-to-treat intergroup differences in cf-PWV changes were assessed by a generalized mixed-effects model with the allocation group as a fixed factor and adjusted for age, sex, changes in mean arterial pressure and the baseline cf-PWV values. Subgroup sensitivity analyses were performed, excluding patients with low CPAP adherence and low cf-PWV at baseline. CPAP and control groups had similar clinic-laboratorial characteristics. Patients had a mean cf-PWV of 9.4 ± 1.6 m/s and 33% presented cf-PWV > 10 m/s. During treatment, the control group had a mean increase in cf-PWV of +0.43 m/s (95% confidence interval [CI], +0.14 to +0.73 m/s; p = .005), whereas the CPAP group had a mean increase of +0.03 m/s (95% CI, −0.33 to +0.39 m/s; p = .87), resulting in a mean difference in changes between CPAP and control of −0.40 m/s (95% CI, −0.82 to +0.02 m/s; p = .059). Subgroup analyses did not change the results. In conclusion, a 6-month CPAP treatment did not reduce aortic stiffness, measured by cf-PWV, in patients with RHT and moderate/severe OSA, but treatment may prevent its progression, in contrast to no-CPAP therapy. K E Y W O R D S aortic stiffness, carotid-femoral pulse wave velocity, continuous positive airway pressure, obstructive sleep apnea, randomized controlled trial, resistant hypertension S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Cardoso CRL, Roderjan CN, Cavalcanti AH, Cortez AF, Muxfeldt ES, Salles GF. Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial. J

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial

Cardoso

Roderjan

Cavalcanti

et al. 2020

Journal of Sleep Research

View full text Add to dashboard Cite

show abstract

“…These effects are reversible by OSA treatment (i.e., CPAP) (Drager et al, 2007;Hui et al, 2012). In a meta-analysis (Ning et al, 2019) of 15 randomized controlled trials that assessed the efficacy of several biomarkers, subgroup analysis showed that CPAP was particularly effective in improving FMD in severe OSA patients and patients with effective CPAP use for ≥ 4 h/night. These findings support the cause and effect relationship between OSA and arteriosclerosis/atherosclerosis.…”

Section: Mechanisms Linking Osa and Arteriosclerosis/atherosclerosismentioning

confidence: 99%

Relationship between cardio-ankle vascular index and obstructive sleep apnea

Tomita¹,

Kasai²

2020

Reviews in Cardiovascular Medicine

View full text Add to dashboard Cite

Patients with obstructive sleep apnea (OSA) are susceptible to developing atherosclerosis. Consequently, such patients are at a high risk of developing cardiovascular diseases, leading to poor prognosis. Many physiological parameters have been previously used to predict the development of atherosclerosis. One such parameter, the cardio-ankle vascular index (CAVI), a measure of arterial stiffness, has garnered much attention as it can also predict the degree of atherosclerosis. The CAVI can be calculated based on noninvasive measurements, and is less susceptible to blood pressure variations at the time of measurement. Therefore, the CAVI can assess changes in arterial stiffness and the risk of developing atherosclerosis independent of blood pressure changes. Continuous positive airway pressure (CPAP) is a standard therapy for OSA and can suppress the issue significantly. Several studies have shown that CPAP treatment for OSA could also reduce the CAVI. In this review, we discuss the relationship between OSA and arterial stiffness, primarily focusing on the CAVI. Furthermore, we propose future perspectives for the CAVI and OSA.

show abstract

International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

show abstract

Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Cited by 45 publications

References 27 publications

Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial

Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial

Relationship between cardio-ankle vascular index and obstructive sleep apnea

International Consensus Statement on Obstructive Sleep Apnea

Contact Info

Product

Resources

About