Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Aug 15;12(8):1143-51.
doi: 10.5664/jcsm.6054.

Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Kiran Khurshid  1 , Jonathan Yabes  2 , Patricia M Weiss  3 , Sushma Dharia  4 , Lee Brown  4 , Mark Unruh  5 , Manisha Jhamb  1
Affiliations
Meta-Analysis

Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Kiran Khurshid et al. J Clin Sleep Med. .

Abstract

Study objectives: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension (HTN). Increasing evidence from animal and human studies suggests that HTN exacerbates OSA. We performed a systematic review and meta-analysis of studies evaluating the effect of anti-hypertensive medications on the severity of OSA.

Methods: A literature search of PubMed and Embase was done using search concepts of OSA, HTN, and drug classes used to treat HTN. Studies that reported changes in the severity of OSA objectively by using apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) were included. Pooled mean difference estimates were calculated. Tests for heterogeneity, publication bias, and subgroup sensitivity analysis were conducted.

Results: Of 27,376 studies screened, only 11 met inclusion criteria, including 5 randomized controlled trials and 6 single-arm prospective trials. The pooled mean difference estimate (95% confidence interval [CI]), based on a random-effects model, was -5.69 (95% CI -10.74 to -0.65), consistent with an overall decrease in AHI or RDI attributable to antihypertensive medications. The effect size was even more pronounced, -14.52 (95% CI -25.65 to -3.39), when only studies using diuretics were analyzed. There was no significant heterogeneity or publication bias among the studies. Meta-regression indicated neither age, baseline AHI, nor change in systolic/diastolic blood pressure influenced the results.

Conclusions: Collectively, findings from these relatively small, short-term studies tend to support the contention that treatment with antihypertensive agents confers a statistically significant, albeit small, reduction in the severity of OSA, which may be more pronounced with the use of diuretics.

Keywords: antihypertensive medications; hypertension; obstructive sleep apnea.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Systematic literature: review process.
Flow chart of study selection process. AHI, apnea-hypopnea index; HTN, hypertension; OSA, obstructive sleep apnea; RCT, randomized controlled trial; RDI, respiratory disturbance index.
Figure 2
Figure 2. Forest plot of effect of antihypertensive treatment on change in severity of obstructive sleep apnea (mean change in apnea-hypopnea index).
The effect size estimate is given for each study expressed in terms of mean differences (MD), with the corresponding 95% confidence internal (CI) indicated by the error bars. The pooled estimate is shown according to the random-effects (RE) model.
Figure 3
Figure 3. Forest plot of effect of diuretic treatment on change in severity of obstructive sleep apnea (mean change in apneahypopnea index).
The effect size estimate is given for each study expressed in terms of mean differences (MD), with the corresponding 95% confidence internal (CI) indicated by the error bars. The pooled estimate is shown according to the random- effects (RE) model.
See this image and copyright information in PMC

References

    1. Somers VK, White DP, Amin R, et al. 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) Circulation. 2008;118:1080–111. - PubMed
    1. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008;52:818–27. - PubMed
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13. - PubMed
    1. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829–36. - PubMed
    1. Grote L, Wutkewicz K, Knaack L, Ploch T, Hedner J, Peter JH. Association between blood pressure reduction with antihypertensive treatment and sleep apnea activity. Am J Hypertens. 2000;13:1280–7. - PubMed

MeSH terms

Substances