Treatment of OSA Improves Control of Hypertension

Does treatment of obstructive sleep apnea (OSA) improve control of hypertension?

Consistent use of nightly continuous positive airway pressure (CPAP) therapy lowers blood pressure (BP) levels in patients with hypertension and OSA. (Strength of Recommendation [SOR]: C, high-quality meta-analyses.) Patients with resistant hypertension should be screened for OSA because nightly CPAP treatment in these patients results in significantly decreased 24-hour systolic and diastolic BP. (SOR: C, meta-analysis.)

A 2022 meta-analysis of randomized controlled trials (RCTs) evaluated the efficacy of CPAP treatment on BP reduction in patients with hypertension and OSA. The study included 19 RCTs and 1,904 patients who were assigned to CPAP treatment, sham CPAP treatment, or a control group. No definition of adequate treatment was included.¹

In the CPAP group, 24-hour systolic and diastolic BP significantly decreased by 5.0 mm Hg (95% CI, −6.9 to −3.1) and 3.3 mm Hg (95% CI, −4.3 to −2.3), respectively. There was also significant decrease in daytime systolic BP of 4.3 mm Hg (95% CI, −6.3 to −2.4) and daytime diastolic BP of 3.0 mm Hg (95% CI, −3.99 to −1.95) compared with the control group. Six studies measured in-office systolic BP and found that CPAP treatment was associated with a significant decrease in systolic BP of 3.7 mm Hg (95% CI, −5.8 to −1.6) and diastolic BP of 2.6 mm Hg (95% CI, −4.3 to −1.0). Subgroup results were consistent with overall results. There were no significant changes in BP levels in the first 3 months of treatment.¹

A 2016 meta-analysis of five RCTs examined the results of CPAP therapy on BP in patients with OSA and resistant hypertension. The studies included 446 patients randomized to a CPAP treatment group or control group with no CPAP treatment. Primary outcomes were the effects of CPAP therapy on 24-hour ambulatory BP and day- and nighttime BP. No definition of adequate treatment was given. Compared with the control group, the CPAP treatment group had reductions in 24-hour systolic BP of 4.78 mm Hg (95% CI, −7.95 to −1.61) and 24-hour diastolic BP of 2.95 mm Hg (95% CI, −5.37 to −0.53).²

A 2022 RCT in Spain assessed the long-term effects of OSA and CPAP treatment on BP in patients with a history of acute coronary syndrome. The study included 1,207 patients with OSA who were initially divided into groups who received CPAP treatment or usual care with antihypertensives. Patients who received CPAP therapy were subdivided into those with good adherence (ie, use for 4 hours or greater per night) and poor adherence (ie, use for less than 4 hours per night). Patients were considered nonadherent if treatment was used for less than 2 hours per night. Patients with poor adherence or nonadherence were combined with the usual care group.³

After 18 months, patients in the CPAP therapy group with good adherence had a significant reduction in mean BP compared with patients in the usual care/poor adherence group, with a maximum mean difference of 4.7 mm Hg (95% CI, −6.7 to −2.7). Similar decreases were shown for systolic and diastolic BP, with maximum mean differences of 5.6 mm Hg (95% CI, −8.5 to −2.6) and 4.4 mm Hg (95% CI, −6.2 to −2.5), respectively.³