Curative effect of continuous positive airway pressure on treatment of patients with obstructive sleep apnea hypopnea syndrome and hypertension: A Meta-analysis / 解放军医学杂志

ABSTRACT

Objective To systematically evaluate the curative effect of continuous positive airway pressure (CPAP) on treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and hypertension. Methods The data were retrieved of randomized controlled trials (RCTs) about the curative effect of CPAP on treatment of patients with OSAHS and hypertension from PubMed, Cochrane Library, CNKI, VIP, CBM and WanFang database from inception to Oct. 2015. Literature screening, data extraction and risk bias assessment were performed by two independent reviewers, and meta-analysis was then carried out by using RevMan 5.3 software. Results A total of 16 RCTs involving 2101 patients were included. Meta-analysis revealed that, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the daytime systolic pressure [MD=–12.60, 95%CI(–17.68 to –7.52), P<0.00001], nighttime systolic pressure [MD=–21.90, 95%CI(–25.94 to –17.86), P<0.00001] and nighttime diastolic pressure [MD=–11.90, 95%CI(–15.44 to –8.36), P<0.00001], while created no significant difference in daytime diastolic pressure, 24-h mean systolic pressure and 24-h mean diastolic pressure in a followingup less than 12 weeks. Whereas in the following-up no less than 12 weeks, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the 24-h mean systolic pressure [MD=–7.88, 95%CI(–12.09 to –3.66), P=0.00002], 24-h mean diastolic pressure [MD=–5.14, 95%CI(–6.00 to –4.28), P<0.00001], daytime systolic pressure [MD=–5.89, 95%CI(–8.79 to –2.98), P<0.0001], daytime diastolic pressure [MD=–4.34, 95%CI(–6.32 to –2.36), P<0.0001]; nighttime systolic pressure [MD=–7.06, 95%CI(–11.12 to –2.99), P=0.0007] and nighttime diastolic pressure [MD=–4.49, 95%CI (–7.39 to –1.58), P=0.006]. Conclusions The current evidences suggest that on the basis of antihypertensive drug therapy, CPAP may effectively reduce the systolic pressure and diastolic pressure of OSAHS patients with hypertension at long-term follow-up, but the effect in a short-term follow-up is not obvious. For the quality and quantity of included studies limited, more high quality and larger sample studies are needed to verify the above conclusion: