• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (98)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Sleep Apnea  • Cardiovascular System  • Quality of Care  • Evidence-Based Medicine  • Randomized Controlled Trial  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Evidence From a Meta-analysis of Placebo-Controlled Randomized Trials

Patrick Haentjens, MD, PhD; Alain Van Meerhaeghe, MD; Antonio Moscariello, MD; Sonia De Weerdt, MD; Kris Poppe, MD, PhD; Alain Dupont, MD, PhD; Brigitte Velkeniers, MD, PhD

Arch Intern Med. 2007;167(8):757-764.

Background  Continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) might lower blood pressure, but evidence from clinical studies is inconsistent, perhaps as a result of small sample size or heterogeneity in study design. This study aimed to assess whether CPAP reduces ambulatory blood pressure in patients with OSAS, to quantify the effect size with precision, and to identify trial characteristics associated with the greatest blood pressure reductions.

Methods  We identified randomized controlled trials of CPAP vs placebo in patients with OSAS specifically reporting 24-hour ambulatory mean blood pressure (MBP).

Results  We included a total of 572 patients from 12 randomized controlled trials. According to a random-effects model, the pooled estimate of the effect of the CPAP intervention was a net decrease of 1.69 mm Hg in 24-hour MBP (95% confidence interval, –2.69 to –0.69). Statistical heterogeneity was moderate (I² = 41%). Predefined metaregression analyses estimated that 24-hour MBP would decrease by 0.89 mm Hg per 10-point increase in apnea-hypopnea index at entry (P = .006), by 0.74 mm Hg for each increase of 10 arousal events per hour slept (P = .008), and by 1.39 mm Hg for each 1-hour increase in effective nightly use of the CPAP device (P = .01).

Conclusions  Among patients with OSAS, CPAP reduces 24-hour ambulatory MBP, with greater treatment-related reductions in ambulatory MBP among patients with a more severe degree of OSAS and a better effective nightly use of the CPAP device. These reductions in blood pressure are likely to contribute to a better prognosis in terms of adverse cardiovascular events.

Author Affiliations: Center for Outcomes Research and Laboratory for Experimental Surgery (Dr Haentjens) and Departments of Pneumology (Dr De Weerdt), Endocrinology (Drs Poppe and Velkeniers), Pharmacology (Dr Dupont), and General Internal Medicine (Drs Poppe and Velkeniers), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; and Service de Pneumologie, Intercommunale de Santé Publique du Pays de Charleroi, Centre Hospitalier Universitaire André Vésale, Montigny-le-Tilleul, Belgium (Drs Van Meerhaeghe and Moscariello).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Self-reported sleep apnoea and mortality in patients from the Swedish Obese Subjects study
Marshall et al.
Eur Respir J 2011;38:1349-1354.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea and Systemic Hypertension: Longitudinal Study in the General Population: the Vitoria Sleep Cohort
Cano-Pumarega et al.
Am. J. Respir. Crit. Care Med. 2011;184:1299-1304.
ABSTRACT | FULL TEXT  

Effects of Continuous Positive Airway Pressure Therapy Withdrawal in Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial
Kohler et al.
Am. J. Respir. Crit. Care Med. 2011;184:1192-1199.
ABSTRACT | FULL TEXT  

Sleep apnoea syndrome in 2011: current concepts and future directions
Levy et al.
Eur Respir Rev 2011;20:134-146.
FULL TEXT  

The Effect of Simulated Obstructive Apnea and Hypopnea on Aortic Diameter and BP
Stowhas et al.
Chest 2011;140:675-680.
ABSTRACT | FULL TEXT  

CPAP treatment of sleep apnoea in the early phase of stroke: growing evidence of effectiveness
Levy and Pepin
Eur Respir J 2011;37:997-999.
FULL TEXT  

Epidemiology of OSA
Lindberg
Sleep Apnoea 2010;1:51-68.
ABSTRACT  

Sleep apnoea and systemic hypertension
Bonsignore et al.
Sleep Apnoea 2010;1:150-173.
ABSTRACT  

Outcomes of OSA and indications for different therapies
Levy et al.
Sleep Apnoea 2010;1:225-243.
ABSTRACT  

Continuous positive airway pressure treatment in patients with OSA
Montserrat et al.
Sleep Apnoea 2010;1:244-266.
ABSTRACT  

Sleep apnoea in chronic heart failure
Naughton and Andreas
Sleep Apnoea 2010;1:396-420.
ABSTRACT  

Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial
Duran-Cantolla et al.
BMJ 2010;341:c5991-c5991.
ABSTRACT | FULL TEXT  

Comparison of Continuous Positive Airway Pressure and Valsartan in Hypertensive Patients with Sleep Apnea
Pepin et al.
Am. J. Respir. Crit. Care Med. 2010;182:954-960.
ABSTRACT | FULL TEXT  

Frequent Loss of Nyctohemeral Rhythm of Intraocular Pressure Restored by nCPAP Treatment in Patients With Severe Apnea
Pepin et al.
Arch Ophthalmol 2010;128:1257-1263.
ABSTRACT | FULL TEXT  

Sleep and Hypertension
Calhoun and Harding
Chest 2010;138:434-443.
ABSTRACT | FULL TEXT  

Control of Hypertension in Nonsleepy Patients with Obstructive Sleep Apnea
Parati and Lombardi
Am. J. Respir. Crit. Care Med. 2010;181:650-652.
FULL TEXT  

Long-term Effect of Continuous Positive Airway Pressure in Hypertensive Patients with Sleep Apnea
Barbe et al.
Am. J. Respir. Crit. Care Med. 2010;181:718-726.
ABSTRACT | FULL TEXT  

Adherence to Sleep Apnea Therapy and Use of Lipid-Lowering Drugs: A Study of the Healthy-User Effect
Platt et al.
Chest 2010;137:102-108.
ABSTRACT | FULL TEXT  

From the author:
Levy
Eur Respir J 2009;34:1210-1211.
FULL TEXT  

Continuous Positive Airway Pressure Treatment Reduces Mortality in Patients with Ischemic Stroke and Obstructive Sleep Apnea: A 5-Year Follow-up Study
Martinez-Garcia et al.
Am. J. Respir. Crit. Care Med. 2009;180:36-41.
ABSTRACT | FULL TEXT  

Sleep and the Cardiovascular System
Yaggi
ACCP Sleep Med Brd Rev 2009;4:123-132.
FULL TEXT  

Positive Airway Pressure Therapy for Obstructive Sleep Apnea Syndrome: The Boards and Beyond
Freedman
ACCP Sleep Med Brd Rev 2009;4:293-312.
FULL TEXT  

Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives
Levy et al.
Eur Respir J 2008;32:1082-1095.
ABSTRACT | FULL TEXT  

Metabolic Syndrome, Obstructive Sleep Apnea, and Continuous Positive Airway Pressure: A Weighty Issue
Yeh et al.
Chest 2008;134:675-676.
FULL TEXT  

Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Somers et al.
Circulation 2008;118:1080-1111.
FULL TEXT  

Cardiorespiratory Fitness and Obstructive Sleep Apnea Syndrome in Morbidly Obese Patients
Vanhecke et al.
Chest 2008;134:539-545.
ABSTRACT | FULL TEXT  

Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Somers et al.
J Am Coll Cardiol 2008;52:686-717.
FULL TEXT  

Sleep Apnea and Hypertension: Interactions and Implications for Management
Kapa et al.
Hypertension 2008;51:605-608.
FULL TEXT  

Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application
Sanders et al.
Proc Am Thorac Soc 2008;5:161-172.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension
Golbin et al.
Proc Am Thorac Soc 2008;5:200-206.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea and Resistant Hypertension: A Case-Control Study
Goncalves et al.
Chest 2007;132:1858-1862.
ABSTRACT | FULL TEXT  

Treating Obstructive Sleep Apnea: Is There More to the Story Than 2 Millimeters of Mercury?
Floras and Bradley
Hypertension 2007;50:289-291.
FULL TEXT  

Does CPAP Lower Blood Pressure in Patients with Sleep Apnea?
JWatch General 2007;2007:2-2.
FULL TEXT