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Meta-Analysis
. 2025 Jan 2;65(1):2400837.
doi: 10.1183/13993003.00837-2024. Print 2025 Jan.

Effect of CPAP therapy on blood pressure in patients with obstructive sleep apnoea: a worldwide individual patient data meta-analysis

Martino F Pengo  1   2 , Esther I Schwarz  3 , Ferran Barbé  4   5 , Peter A Cistulli  6   7 , Luciano F Drager  8 , Cristiano Fava  9 , Flávio D Fuchs  10 , Mary S M Ip  11 , Kelly A Loffler  12 , Macy M S Lui  11 , Miguel Ángel Martínez-García  5   13 , Doug McEvoy  12 , Yüksel Peker  14   15   16 , Craig L Phillips  17 , Tim Quinnell  18 , Davide Soranna  19 , Joerg Steier  20 , John R Stradling  21 , Antonella Zambon  19   22 , Gianfranco Parati  23   2 ; ANDANTE collaborators
Collaborators, Affiliations
Meta-Analysis

Effect of CPAP therapy on blood pressure in patients with obstructive sleep apnoea: a worldwide individual patient data meta-analysis

Martino F Pengo et al. Eur Respir J. .

Abstract

Background: Obstructive sleep apnoea (OSA) is associated with hypertension, and OSA treatment can reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP), but with a modest mean effect size and vast heterogeneity among studies. The aim of this individual patient data (IPD) meta-analysis was to understand which OSA phenotypes could benefit the most in terms of BP reduction.

Methods: A systematic review of randomised controlled trials that compared continuous positive airway pressure (CPAP) with either passive or active treatment was conducted. Studies were eligible if they included adult patients with OSA diagnosed by full polysomnography or cardiorespiratory polygraphy (defined as apnoea-hypopnoea index >5 events·h-1) and if BP was measured both before and after CPAP treatment.

Results: In total, 36 parallel studies (n=9434 patients) were included. CPAP treatment was associated with BP reduction in patients with uncontrolled office SBP only, while BP was not reduced by CPAP in patients with controlled BP (SBP -2.6 versus 0 mmHg; p<0.0001; DBP -1.7 versus -1 mmHg; p=0.091). Differences were seen also when BP changes were compared between patients aged ≤60 versus >60 years after multiple imputation only (p=0.0127 for SBP and p=0.017 for DBP). No differences were seen in terms of BP reduction when comparing patients with/without severe nocturnal hypoxia.

Conclusions: This IPD meta-analysis of the BP effects of OSA treatment with CPAP shows that OSA patients with uncontrolled BP at baseline benefit the most from CPAP therapy in terms of BP reduction. These results have important implications for the decision on how to best manage arterial hypertension associated with OSA.

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Conflict of interest statement

Conflict of Interest: E.I. Schwarz reports grants from Löwenstein Medical AG, Philips and LUNGE Zürich. P.A. Cistulli reports grants or contracts from ResMed, ResMed Foundation and SomnoMed for the provision of grant funds or equipment for investigator-initiated research, consulting fees from ResMed (paid to institution), and SomnoMed, Signifier Medical, Bayer and Sunrise (paid to consultant), and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from SomnoMed (paid to speaker). L.F. Drager reports grants from FAPESP (Brazilian Funding Agency; grant 2019/23496-8) and consulting fees from ResMed (consultant for real-world data on PAP telemonitoring). C. Fava reports payment or honoraria for lectures, presentations, manuscript writing or educational events from Menarini and Novartis. M.S.M. Ip reports grants from Li Ka Shing Foundation. T. Quinnell reports grants from the UK NIHR for the PAPMAT study, with payments to their institution only, fees for an educational talk on sleep apnoea at Cambridge University Medical School, and a consultancy agreement with Jazz Pharma UK Ltd that included services in return for registration, accommodation, travel and subsistence at the World Sleep Conference in Rome; T. Quinnell is the President and then Past President of the British Sleep Society (unpaid), and the Chair of the Sleep Apnoea Specialty Advisory Group for the British Thoracic Society, and is also the Director of their own company, TNQ Medical Ltd, where they conduct private medical work. The remaining authors have no potential conflicts of interest to disclose.

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