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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

Imran H Iftikhar  1 , Christopher W Valentine, Lia R A Bittencourt, Debbie L Cohen, Annette C Fedson, Thorarinn Gíslason, Thomas Penzel, Craig L Phillips, Lin Yu-sheng, Allan I Pack, Ulysses J Magalang
Affiliations
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. 2014 Dec.

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.

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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.
See this image and copyright information in PMC

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