Pengo Martino F, Schwarz Esther I, Barbé Ferran, Cistulli Peter A, Drager Luciano F, Fava Cristiano, Fuchs Flávio D, Ip Mary S M, Loffler Kelly A, Lui Macy M S, Martínez-García Miguel Ángel, McEvoy Doug, Peker Yüksel, Phillips Craig L, Quinnell Tim, Soranna Davide, Steier Joerg, Stradling John R, Zambon Antonella, Parati Gianfranco
Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Eur Respir J. 2025 Jan 2;65(1). doi: 10.1183/13993003.00837-2024. Print 2025 Jan.
Obstructive sleep apnoea (OSA) is associated with hypertension, and OSA treatment can reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP), but with a modest mean effect size and vast heterogeneity among studies. The aim of this individual patient data (IPD) meta-analysis was to understand which OSA phenotypes could benefit the most in terms of BP reduction.
A systematic review of randomised controlled trials that compared continuous positive airway pressure (CPAP) with either passive or active treatment was conducted. Studies were eligible if they included adult patients with OSA diagnosed by full polysomnography or cardiorespiratory polygraphy (defined as apnoea-hypopnoea index >5 events·h) and if BP was measured both before and after CPAP treatment.
In total, 36 parallel studies (n=9434 patients) were included. CPAP treatment was associated with BP reduction in patients with uncontrolled office SBP only, while BP was not reduced by CPAP in patients with controlled BP (SBP -2.6 0 mmHg; p<0.0001; DBP -1.7 -1 mmHg; p=0.091). Differences were seen also when BP changes were compared between patients aged ≤60 >60 years after multiple imputation only (p=0.0127 for SBP and p=0.017 for DBP). No differences were seen in terms of BP reduction when comparing patients with/without severe nocturnal hypoxia.
This IPD meta-analysis of the BP effects of OSA treatment with CPAP shows that OSA patients with uncontrolled BP at baseline benefit the most from CPAP therapy in terms of BP reduction. These results have important implications for the decision on how to best manage arterial hypertension associated with OSA.
阻塞性睡眠呼吸暂停（OSA）与高血压相关，OSA治疗可降低收缩压（SBP）和舒张压（DBP），但平均效应量较小，且研究间存在很大异质性。本个体患者数据（IPD）荟萃分析的目的是了解哪些OSA表型在降低血压方面获益最大。
对比较持续气道正压通气（CPAP）与被动或主动治疗的随机对照试验进行系统评价。纳入标准为研究对象包括经全夜多导睡眠图或心肺多导睡眠图诊断为OSA的成年患者（定义为呼吸暂停低通气指数>5次·小时），且在CPAP治疗前后均测量血压。
共纳入36项平行研究（n = 9434例患者）。CPAP治疗仅与诊室SBP未得到控制的患者血压降低相关，而血压得到控制的患者CPAP治疗后血压未降低（SBP -2.6±0 mmHg；p<0.0001；DBP -1.7±1 mmHg；p = 0.091）。仅在多次插补后比较年龄≤60岁和>60岁患者的血压变化时也观察到差异（SBP p = 0.0127，DBP p = 0.017）。比较有无严重夜间低氧血症的患者，在血压降低方面未观察到差异。
这项关于CPAP治疗OSA对血压影响的IPD荟萃分析表明，基线血压未得到控制的OSA患者在降低血压方面从CPAP治疗中获益最大。这些结果对于如何最佳管理与OSA相关的动脉高血压的决策具有重要意义。
