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Meta-Analysis
. 2014 Dec;32(12):2341-50; discussion 2350.
doi: 10.1097/HJH.0000000000000372.

Effects of Continuous Positive Airway Pressure on Blood Pressure in Patients With Resistant Hypertension and Obstructive Sleep Apnea: A Meta-Analysis

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Free PMC article
Meta-Analysis

Effects of Continuous Positive Airway Pressure on Blood Pressure in Patients With Resistant Hypertension and Obstructive Sleep Apnea: A Meta-Analysis

Imran H Iftikhar et al. J Hypertens. .
Free PMC article

Abstract

Objective: To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).

Methods: Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.

Results: A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I² 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I² 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I² 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I² 76%), respectively, in favor of the CPAP group.

Conclusion: The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.

Conflict of interest statement

Conflicts of interest

None of the authors have conflicts of interest with respect to this article.

This was not an industry-sponsored study.

Figures

FIGURE 1
FIGURE 1
Flow diagram of articles identified and evaluated during the study selection process.
FIGURE 2
FIGURE 2
Forest plot for the mean change in 24-h SBP with the corresponding 95% confidence interval (CI).
FIGURE 3
FIGURE 3
Forest plot for the mean change in 24-h DBP with the corresponding 95% confidence interval (CI).
FIGURE 4
FIGURE 4
Forest plot for the mean change in 24-h SBP from the randomized controlled trials with the corresponding 95% confidence interval (CI).
FIGURE 5
FIGURE 5
Forest plot for the mean change in 24-h DBP from randomized controlled trials with the corresponding 95% confidence interval (CI).
FIGURE 6
FIGURE 6
Funnel plot for the assessment of publication bias.

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