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Meta-Analysis
. 2024 Aug 1;7(8):e2427557.
doi: 10.1001/jamanetworkopen.2024.27557.

Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnancy: A Systematic Review and Meta-Analysis

Yi-Chieh Lee  1   2 , Yun-Chen Chang  3 , Liang-Wei Tseng  4 , Wan-Ni Lin  3 , Chun-Ting Lu  1 , Li-Ang Lee  3   5 , Tuan-Jen Fang  3   5 , Wen-Nuan Cheng  6 , Hsueh-Yu Li  3   5
Affiliations
Meta-Analysis

Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnancy: A Systematic Review and Meta-Analysis

Yi-Chieh Lee et al. JAMA Netw Open. .

Abstract

Importance: Pregnancy may contribute to the development or exacerbation of obstructive sleep apnea (OSA) and increase the risk of gestational complications. Continuous positive airway pressure (CPAP) is the first-line and criterion standard treatment for OSA and is regarded as the most feasible choice during pregnancy. However, the association between CPAP therapy in pregnant women with OSA and reduced gestational complications remains inconclusive.

Objective: To investigate the association between CPAP therapy in pregnant women with OSA and the reduction of adverse hypertensive outcomes during gestation.

Data sources: Keyword searches of PubMed, Embase, and the Cochrane Database of Systematic Reviews and Clinical Trials were conducted from inception to November 5, 2023.

Study selection: Original studies reporting the treatment effect of CPAP use on lowering hypertension and preeclampsia risks in pregnant women with OSA were selected.

Data extraction and synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed in the reporting of reviews. Data were independently extracted by 2 authors. Random-effects model meta-analyses were performed and risk ratios (RRs) reported. Subgroup analysis, meta-regression based on age and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and publication bias assessment were also conducted.

Main outcome and measures: The primary outcome was the RR of gestational hypertension and preeclampsia between pregnant women with OSA receiving CPAP treatment and those who did not receive CPAP treatment.

Results: Six original studies in 809 participants (mean age, 31.4 years; mean BMI, 34.0) were identified and systematically reviewed for meta-analysis. The pooled results showed significant differences between the intervention (CPAP use) and the control (non-CPAP use) groups in reducing the risk of gestational hypertension (RR, 0.65; 95% CI, 0.47-0.89; P = .008) and preeclampsia (RR, 0.70; 95% CI, 0.50-0.98; P = .04). Meta-regression revealed that patients' age (coefficient, -0.0190; P = .83) and BMI (coefficient, -0.0042; P = .87) were not correlated with reduction of risk of hypertension and preeclampsia.

Conclusions and relevance: These findings suggest that implementing CPAP treatment in pregnant women with OSA may reduce the risk of gestational hypertension and preeclampsia.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. PRISMA Flow Diagram for the Meta-Analysis
Figure 2.
Figure 2.. Pooled Risk Ratios (RRs) for Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnant Women
The 95% CI was calculated using random-effects model meta-analysis.
Figure 3.
Figure 3.. Subgroup Analysis of Type of Study
The 95% CI was calculated using random-effects model meta-analysis.
Figure 4.
Figure 4.. Trim-and-Fill Funnel Plots of Included Trials
The black circles represent the observed studies; the white circle in panel B represents the imputed study by the trim-and-fill method. The vertical line represents the overall estimated effect if corrected by the trim-and-fill analysis for publication bias.
See this image and copyright information in PMC

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