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. 2019 Sep 2;8(9):1367.
doi: 10.3390/jcm8091367.

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

Cesare Cuspidi  1   2 , Marijana Tadic  3 , Carla Sala  4 , Elisa Gherbesi  4 , Guido Grassi  1 , Giuseppe Mancia  1
Affiliations

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

Cesare Cuspidi et al. J Clin Med. .

Abstract

Aim: We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM).

Design: The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: "obstructive sleep apnea", "sleep quality", "non dipping", "reduced nocturnal BP fall", "circadian BP variation", "night-time BP", and "ambulatory blood pressure monitoring".

Results: Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0-90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0-65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07-1.89, p < 0.01). After the exclusion of patients with mild OSA, OR increased to 1.67 (CI: 1.21-2.28, p < 0.001).

Conclusions: The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping.

Keywords: meta-analysis; non-dipping pattern; obstructive sleep apnea.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic flow-chart for the selection of studies.
Figure 2
Figure 2
Forest plot of prevalence rates of a non-dipping pattern during 24-h blood pressure monitoring in patients with obstructive sleep apnea (OSA) [15,16,17,18,19,20,21,22,23,24,25,26,27,28]. Data from 14 studies and 1562 participants. Random model (I2 = 79%).
Figure 3
Figure 3
Odds ratio of the non-dipping pattern during 24-h blood pressure monitoring in patients with obstructive sleep apnea vs. without obstructive sleep apnea (OSA) [16,18,19,20,24,26,27]. Data from seven studies and 1330 participants with and without OSA. Fixed model (I2 = 56%).
Figure 4
Figure 4
Odds ratio of non-dipping pattern during 24-h blood pressure monitoring in patients with obstructive sleep apnea (OSA) of moderate to a severe degree compared to controls [18,19,20,24,26,27]. Data from six studies and 1198 participants with and without OSA. Fixed model (I2 = 59).
Figure 5
Figure 5
Publication bias of the non-dipping pattern in obstructive sleep apnea OSA patients: Observed odds ratio 1.50 (1.14–1.98). Adjusted odds ratio 1.37 (1.05–1.79). White symbols refer to observed data. Black symbols refer to adjusted data.
See this image and copyright information in PMC

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