Approaches for Lowering Blood Pressure in Patients with Obstructive Sleep Apnea

Summary and Comment |
December 3, 2015

Approaches for Lowering Blood Pressure in Patients with Obstructive Sleep Apnea

  1. Thomas L. Schwenk, MD

Continuous positive airway pressure and mandibular advancement devices performed similarly.

  1. Thomas L. Schwenk, MD

Obstructive sleep apnea (OSA) is associated with nighttime oxygen desaturation, elevated blood pressure (BP), and excess risk for cardiovascular disease. The BP-lowering effect of two major treatments for OSA — continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) — was assessed in this meta-analysis of 51 randomized trials (4888 patients) in which CPAP or MADs were compared mostly with inactive controls.

During mean follow-up of 4 to 15 weeks, CPAP was associated with mean reductions in systolic and diastolic BPs of 2.5 mm Hg and 2.1 mm Hg, respectively; corresponding reductions in systolic and diastolic BPs with MADs were 2.0 mm Hg and 1.9 mm Hg. The magnitude of BP lowering with CPAP correlated with duration of nightly CPAP use.

Comment

This meta-analysis resolves the uncertainty of previous studies and analyses about the effects of CPAP and MADs on BP lowering in OSA patients. Both treatments, compared with inactive controls, are associated with average drops in BP of about 2 mm Hg, but the clinical importance of such small reductions is not addressed in this analysis

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

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