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Original Research: Sleep Disorders |

Effect of CPAP on Blood Pressure in Patients With OSA/HypopneaEffect of CPAP on Blood Pressure in OSA: A Systematic Review and Meta-analysis

Cristiano Fava, MD, PhD; Stefania Dorigoni, MD; Francesco Dalle Vedove, MD; Elisa Danese, PharmD; Martina Montagnana, MD; Gian Cesare Guidi, MD; Krzysztof Narkiewicz, MD, PhD; Pietro Minuz, MD
Author and Funding Information

From the Department of Medicine (Drs Fava, Dorigoni, Dalle Vedove, Danese, and Minuz), Division of Internal Medicine C, and Department of Life and Reproduction Sciences (Drs Danese, Montagnana, and Guidi), Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy; and Department of Hypertension and Diabetology (Dr Narkiewicz), Medical University of Gdańsk, Gdańsk, Poland.

Correspondence to: Cristiano Fava, MD, PhD, Department of Medicine, Division of Internal Medicine C, Piazzale LA Scuro 10, 37134 Verona, Italy; e-mail: cristiano.fava@med.lu.se


Drs Dorigoni and Dalle Vedove contributed equally to this work.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):762-771. doi:10.1378/chest.13-1115
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Background:  CPAP is considered the therapy of choice for OSA, but the extent to which it can reduce BP is still under debate. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to quantify the effect size of the reduction of BP by CPAP therapy compared with other passive (sham CPAP, tablets of placebo drug, conservative measures) or active (oral appliance, antihypertensive drugs) treatments.

Methods:  We searched four different databases (MEDLINE, EMBASE, Web of Science, and the Cochrane Library) with specific search terms and selection criteria.

Results:  From 1,599 articles, we included 31 RCTs that compared CPAP with either passive or active treatment. In a random-effects meta-analysis vs passive treatment (29 RCTs, 1,820 subjects), we observed a mean ± SEM net difference in systolic BP of 2.6 ± 0.6 mm Hg and in diastolic BP of 2.0 ± 0.4 mm Hg, favoring treatment with CPAP (P < .001). Among studies using 24-h ambulatory BP monitoring that presented data on daytime and nighttime periods, the mean difference in systolic and diastolic BP was, respectively, 2.2 ± 0.7 and 1.9 ± 0.6 mm Hg during daytime and 3.8 ± 0.8 and 1.8 ± 0.6 mm Hg during nighttime. In meta-regression analysis, a higher baseline apnea/hypopnea index was associated with a greater mean net decrease in systolic BP (β ± SE, 0.08 ± 0.04). There was no evidence of publication bias, and heterogeneity was mild (I2, 34%-36%).

Conclusions:  Therapy with CPAP significantly reduces BP in patients with OSA but with a low effect size. Patients with frequent apneic episodes may benefit the most from CPAP.

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