RT Journal Article
SR Electronic
T1 Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1901945
DO 10.1183/13993003.01945-2019
VO 55
IS 5
A1 Martino F. Pengo
A1 Davide Soranna
A1 Alice Giontella
A1 Elisa Perger
A1 Paola Mattaliano
A1 Esther Irene Schwarz
A1 Carolina Lombardi
A1 Grzegorz Bilo
A1 Antonella Zambon
A1 Joerg Steier
A1 Gianfranco Parati
A1 Pietro Minuz
A1 Cristiano Fava
YR 2020
UL http://erj.ersjournals.com/content/55/5/1901945.abstract
AB The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of −2.09 (95% CI −2.78– −1.40) mmHg for systolic BP and −1.92 (95% CI −2.40– −1.43) mmHg for diastolic BP and −1.27 (95% CI −2.34– −0.20) mmHg for systolic BP and −1.11 (95% CI −1.82– −0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP −2.93 mmHg), with uncontrolled BP at baseline (systolic BP −4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <77%) at baseline (24-h systolic BP −7.57 mmHg).Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of BP control. These findings should be interpreted with caution; however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.This study identified age, blood pressure levels before treatment and hypoxic burden expressed by the minimum desaturation as potential predictors of blood pressure reduction in patients treated for obstructive sleep apnoea http://bit.ly/31LdrJA