Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity

J Clin Sleep Med. 2014 Apr 15;10(4):365-9. doi: 10.5664/jcsm.3604.


Study objectives: We sought to perform a patient-level meta-analysis using the individual patient data of the trials identified in our previous study-level meta-analysis investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP).

Design: Patient-level meta-analysis.

Setting: N/A.

Participants: 968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials.

Interventions: Therapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week.

Measurements and results: The mean reductions in BP between PAP and non-therapeutic control arms were -2.27 mm Hg (95% CI -4.01 to -0.54) for systolic BP and -1.78 mm Hg (95% CI -2.99 to -0.58) for diastolic BP. The presence of uncontrolled hypertension at baseline was significantly associated with a reduction in systolic BP of 7.1 mm Hg and diastolic BP of 4.3 mm Hg after controlling for OSA severity (apnea-hypopnea index, Epworth Sleepiness Scale score, PAP level), patient demographics (age, gender, body mass index, use of antihypertensive medication/s), and measures of PAP efficacy (PAP adherence and treatment duration).

Conclusions: OSA patients with uncontrolled hypertension are likely to gain the largest benefit from PAP in terms of a substantial reduction in BP, even after controlling for disease severity.

Keywords: Patient-level meta-analysis; hypertension; lung; obstructive sleep apnea; positive airway pressure.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Pressure / physiology
  • Continuous Positive Airway Pressure*
  • Female
  • Humans
  • Hypertension / physiopathology*
  • Male
  • Middle Aged
  • Remission Induction
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Apnea, Obstructive / therapy*