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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 journalArticle

Martino Pengo, D. Soranna, A. Giontella, E. Perger, P Mattaliano, Esther Irene Schwarz, C. Lombardi, G Bilo, A. Zambon, Joerg Sebastian Steier, Gianfranco Parati, Pietro Minuz, Cristiano Fava

Original languageEnglish
Article numberERJ-01945-2019.R1
JournalEuropean Respiratory Journal
Publication statusPublished - 7 Feb 2020

King's Authors

Abstract

The treatment for obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) is associated with blood pressure (BP) re-duction however, the overall effect is modest. The aim of this systematic review and meta-analysis of RCTs comparing the effect of CPAP and/or MAD on BP was to identify subgroups and phenotypes of patients who respond best to treatment. The article search was performed in three different databases (MEDLINE, EMBASE and Web of Science) with specific search terms and selection criteria. From 2,289 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 a net average BP reduction compared to passive treatment 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 specifically showed a greater response were: those younger than 60 years (sys-tolic BP -2.93 mmHg), those with uncontrolled BP at baseline (systolic BP -4.14 mmHg) and those with severe oxygen desaturations (SpO2-nadir<77%) at baseline (24h systolic BP -7.57 mmHg). Even if our meta-analysis, in line with previous ones, shows that the expected reduction of BP by CPAP/MADs is modest in OSA patients, it identifies specific subgroups that benefit the most from treatment. These findings should be interpreted with caution, however, they are particularly important for those with uncontrolled BP at baseline who require additional anti-hypertensive therapy.

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