• Jessie P Bakker, Bradley A Edwards, Shiva P Gautam, Sydney B Montesi, Joaquín Durán-Cantolla, Felipe Aizpuru, Felipe Aizpuru Barandiarán, Ferran Barbé, Manuel Sánchez-de-la-Torre, and Atul Malhotra.
• Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA.
• J Clin Sleep Med. 2014 Apr 15; 10 (4): 365-9.

Study ObjectivesWe sought to perform a patient-level meta-analysis using the individual patient data of the trials identified in our previous study-level meta-analysis investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP).DesignPatient-level meta-analysis.SettingN/A.Participants968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials.InterventionsTherapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week.Measurements And ResultsThe mean reductions in BP between PAP and non-therapeutic control arms were -2.27 mm Hg (95% CI -4.01 to -0.54) for systolic BP and -1.78 mm Hg (95% CI -2.99 to -0.58) for diastolic BP. The presence of uncontrolled hypertension at baseline was significantly associated with a reduction in systolic BP of 7.1 mm Hg and diastolic BP of 4.3 mm Hg after controlling for OSA severity (apnea-hypopnea index, Epworth Sleepiness Scale score, PAP level), patient demographics (age, gender, body mass index, use of antihypertensive medication/s), and measures of PAP efficacy (PAP adherence and treatment duration).ConclusionsOSA patients with uncontrolled hypertension are likely to gain the largest benefit from PAP in terms of a substantial reduction in BP, even after controlling for disease severity.

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