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
. 2022 May;15(5):1238-1248.
doi: 10.1111/cts.13241. Epub 2022 Feb 24.

Weight reduction added to CPAP decreases blood pressure and triglyceride level in OSA: Systematic review and meta-analysis

Dóra K Kovács  1 , Noémi Gede  1 , László Szabó  1 , Péter Hegyi  2   3   4 , Zsolt Szakács  1 , Béla Faludi  5 , Ágnes Sebők  5 , András Garami  1 , Margit Solymár  1 , Dániel Kósa  1 , Lilla Hanák  1 , Zoltán Rumbus  1 , Márta Balaskó  1
Affiliations
Meta-Analysis

Weight reduction added to CPAP decreases blood pressure and triglyceride level in OSA: Systematic review and meta-analysis

Dóra K Kovács et al. Clin Transl Sci. 2022 May.

Abstract

Obstructive sleep apnea (OSA) is associated with treatment-resistant hypertension and high cardiovascular risk. Continuous positive airway pressure (CPAP) fails to reduce cardiovascular risks consistently. Obesity and OSA show reciprocal association and they synergistically increase hypertension via different pathways. Our meta-analysis aimed to assess the cardiovascular benefits of combining weight loss (WL) with CPAP (vs. WL or CPAP alone) in OSA. Outcomes included systolic and diastolic blood pressure (BP) and blood lipid parameters. We explored Medline, Embase, Cochrane, and Scopus. Eight randomized controlled studies (2627 patients) were included. The combined therapy decreased systolic BP more than CPAP alone. Weighted mean difference (WMD) for CPAP + WL versus CPAP was -8.89 mmHg, 95% confidence interval (95% CI; -13.67 to -4.10, p < 0.001) for systolic BP. For diastolic BP, this decrease was not significant. In case of blood lipids, the combined treatment decreased triglyceride levels more than CPAP alone (WMD = -0.31, 95% CI -0.58 to -0.04, p = 0.027). On the other hand, addition of CPAP to WL failed to suppress BP further. The certainty of evidence according to GRADE was very low to moderate. In conclusion, our results showed that the addition of WL to CPAP significantly improved BP and blood lipid values in OSA. On the other hand, the addition of CPAP to WL could not significantly improve BP or blood lipid values. Review protocol: PROSPERO CRD42019138998.

PubMed Disclaimer

Conflict of interest statement

The authors declared no competing interests for this work.

Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flowchart. RCT, randomized controlled trial
FIGURE 2
FIGURE 2
Forest plot representing reduction of systolic blood pressure (SBP) after CPAP + WL versus CPAP therapies. Squares show the weighted mean difference (WMD) of SBP after continuous positive pressure ventilation (CPAP) + weight loss (WL) versus CPAP therapies. The grey area reflects the weight assigned to the study. Horizontal bars indicate 95% confidence intervals (95% CIs). The diamond shows the overall WMD with its corresponding 95% CI. N, number of participants
FIGURE 3
FIGURE 3
Forest plot representing reduction of diastolic blood pressure (DBP) after CPAP + WL versus CPAP therapies. Squares show the weighted mean difference (WMD) of DBP after continuous positive pressure ventilation (CPAP) + weight loss (WL) versus CPAP therapies. The grey area reflects the weight assigned to the study. Horizontal bars indicate 95% confidence intervals (95% CIs). The diamond shows the overall WMD with its corresponding 95% CI. N, number of participants
FIGURE 4
FIGURE 4
Forest plot representing reduction of systolic blood pressure (SBP) after CPAP + WL versus WL therapies. Squares show the weighted mean difference (WMD) of SBP after continuous positive pressure ventilation (CPAP) + weight loss (WL) versus WL therapies. The grey area reflects the weight assigned to the study. Horizontal bars indicate 95% confidence intervals (95% CIs). The diamond shows the overall WMD with its corresponding 95% CI. N, number of participants
FIGURE 5
FIGURE 5
Forest plot representing reduction of diastolic blood pressure (DBP) after CPAP + WL versus WL therapies. Squares show the weighted mean difference (WMD) of DBP after continuous positive pressure ventilation (CPAP) + weight loss (WL) versus WL therapies. The grey area reflects the weight assigned to the study. Horizontal bars indicate 95% confidence intervals (95% CIs). The diamond shows the overall WMD with its corresponding 95% CI. N, number of participants
FIGURE 6
FIGURE 6
Forest plot representing reduction of blood triglyceride (TG) level after CPAP + WL versus CPAP therapies. Squares show the weighted mean difference (WMD) of blood TG level after continuous positive pressure ventilation (CPAP) + weight loss (WL) versus CPAP therapies. The grey area reflects the weight assigned to the study. Horizontal bars indicate 95% confidence intervals (95% CIs). The diamond shows the overall WMD with its corresponding 95% CI. N, number of participants
See this image and copyright information in PMC

References

    1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature‐based analysis. Lancet Respir Med. 2019;7(8):687‐698. - PMC - PubMed
    1. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70‐81. - PubMed
    1. Labarca G, Dreyse J, Drake L, Jorquera J, Barbe F. Efficacy of Continuous Positive Airway Pressure (CPAP) in the prevention of cardiovascular events in patients with obstructive sleep apnea: systematic review and meta‐analysis. Sleep Med Rev. 2020;52:101312. - PubMed
    1. Hou H, Zhao Y, Yu W, et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta‐analysis. J Glob Health. 2018;8(1):010405. - PMC - PubMed
    1. Marcus JA, Pothineni A, Marcus CZ, Bisognano JD. The role of obesity and obstructive sleep apnea in the pathogenesis and treatment of resistant hypertension. Curr Hypertens Rep. 2014;16(1):411. - PubMed

Publication types