Department of Medicine, Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy.
Department of Medicine, Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy.
Chest. 2014 Apr;145(4):762-771. doi: 10.1378/chest.13-1115.
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.
We searched four different databases (MEDLINE, EMBASE, Web of Science, and the Cochrane Library) with specific search terms and selection criteria.
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 (beta±SE, 0.08±0.04). There was no evidence of publication bias, and heterogeneity was mild ( I2, 34%-36%).
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.
CPAP 被认为是 OSA 的首选治疗方法，但 CPAP 降低血压的程度仍存在争议。我们进行了系统评价和荟萃分析，以量化 CPAP 治疗与其他被动（假 CPAP、安慰剂药物片、保守措施）或主动（口腔器具、降压药物）治疗相比降低血压的效果大小。
我们使用特定的搜索词和选择标准在四个不同的数据库（MEDLINE、EMBASE、Web of Science 和 Cochrane Library）中进行了搜索。
从 1599 篇文章中，我们纳入了 31 项比较 CPAP 与被动或主动治疗的 RCT。在一项针对被动治疗（29 项 RCT，1820 例患者）的随机效应荟萃分析中，我们观察到 CPAP 治疗的收缩压平均净差异为 2.6±0.6mmHg，舒张压平均净差异为 2.0±0.4mmHg，有利于 CPAP 治疗（P<.001）。在使用 24 小时动态血压监测并提供日间和夜间数据的研究中，日间收缩压和舒张压的平均差异分别为 2.2±0.7mmHg 和 1.9±0.6mmHg，夜间为 3.8±0.8mmHg 和 1.8±0.6mmHg。在元回归分析中，较高的基线呼吸暂停/低通气指数与收缩压平均净下降幅度较大相关（β±SE，0.08±0.04）。没有发现发表偏倚的证据，异质性较低（ I2，34%-36%）。
CPAP 治疗可显著降低 OSA 患者的血压，但效果较小。频繁发生呼吸暂停的患者可能从 CPAP 中获益最大。
