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Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis

Research output: Contribution to journalReview article

Martino F Pengo, Davide Soranna, Alice Giontella, Elisa Perger, Paola Mattaliano, Esther Irene Schwarz, Carolina Lombardi, Grzegorz Bilo, Antonella Zambon, Joerg Steier, Gianfranco Parati, Pietro Minuz, Cristiano Fava

Original languageEnglish
JournalEuropean Respiratory Journal
Publication statusE-pub ahead of print - 20 Feb 2020

Bibliographical note

Copyright ©ERS 2020.

King's Authors


The treatment for obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) is associated with blood pressure (BP) reduction however, the overall effect is modest. The aim of this systematic review and meta-analysis of RCTs comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MAD with either passive or active treatment. When all the studies are pooled together, CPAP and MAD are associated with an average BP reduction of -2.09 (-2.78, -1.40) mmHg [mean (95%CI)] for the systolic and of -1.92 (-2.40, -1.43) mmHg for the diastolic BP, and of -1.27 (-2.34, -0.20) mmHg for systolic and of -1.11 (-1.82, -0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those: younger than 60 years (systolic BP -2.93 mmHg), with uncontrolled BP at baseline (systolic BP -4.14 mmHg) and with severe oxygen desaturations (SpO2-nadir<77%) at baseline (24 h systolic BP -7.57 mmHg).Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of blood pressure control. These findings should be interpreted with caution, however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.

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