Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-12-2016 | Review Article

Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis

Authors: Xin Lin, Gongping Chen, Jiachao Qi, Xiaofang Chen, Jiangming Zhao, Qichang Lin

Published in: European Archives of Oto-Rhino-Laryngology | Issue 12/2016

Abstract

Arterial stiffness has been recognized as a predictor of cardiovascular and all-cause mortality in hypertensive patients. However, the impact of continuous positive airway pressure (CPAP) on arterial stiffness in patients with OSA and hypertension remains inconclusive. We performed a meta-analysis to determine whether effective CPAP therapy could decrease arterial stiffness. Two reviewers independently searched PubMed, Embase, Web of Science and Cochrane Library prior to March 5, 2015. Information on characteristics of subjects, study design and pre- and post-CPAP treatment of arterial stiffness was extracted for analysis. Standardized mean difference (SMD) was used to analyze the summary estimates for CPAP therapy. Three articles with 186 patients were included in this meta-analysis, including two observational studies and one randomized controlled study. The meta-analysis showed that CPAP was associated with a statistically significant decrease in arterial stiffness in patients with OSA and hypertension (SMD = −0.65, 95 % confidence interval (CI) = −1.14 to −0.16, z = 2.60, p = 0.009). Our meta-analysis suggested that CPAP among OSA and hypertensive patients was significantly associated with a decrease in arterial stiffness. Further prospective large-scale multicenter RCTs are needed to explore the precise impact of CPAP therapy on arterial stiffness in patients with OSA and hypertension.

White DP (1995) Sleep-related breathing disorder. 2. Pathophysiology of obstructive sleep apnoea. Thorax 50:797–804CrossRefPubMedPubMedCentral

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235. doi:10.1056/nejm199304293281704 CrossRefPubMed

Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318. doi:10.1016/s2213-2600(15)00043-0 CrossRefPubMedPubMedCentral

Partinen M, Guilleminault C (1990) Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest 97:27–32CrossRefPubMed

Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A (2001) Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 37:1236–1241CrossRefPubMed

Doonan RJ, Scheffler P, Lalli M, Kimoff RJ, Petridou ET, Daskalopoulos ME, Daskalopoulou SS (2011) Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertens Res 34:23–32. doi:10.1038/hr.2010.200 CrossRefPubMed

Vlachantoni IT, Dikaiakou E, Antonopoulos CN, Stefanadis C, Daskalopoulou SS, Petridou ET (2013) Effects of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea in arterial stiffness: a meta-analysis. Sleep Med Rev 17:19–28. doi:10.1016/j.smrv.2012.01.002 CrossRefPubMed

Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD (1991) Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest 99:861–866CrossRefPubMed

Silverberg DS, Oksenberg A, Iaina A (1997) Sleep related breathing disorders are common contributing factors to the production of essential hypertension but are neglected, underdiagnosed, and undertreated. Am J Hypertens 10:1319–1325CrossRefPubMed

10.

Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 19:2271–2277CrossRefPubMed

11.

Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239CrossRefPubMed

12.

Baguet JP, Hammer L, Levy P, Pierre H, Rossini E, Mouret S, Ormezzano O, Mallion JM, Pepin JL (2005) Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients. J Hypertens 23:521–527CrossRefPubMed

13.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. doi:10.1136/bmj.327.7414.557 CrossRefPubMedPubMedCentral

14.

Sukmarova Z, Litvin AY, Rogoza A, Chazova I (2009) Reduction of arterial stiffness and central bp in patients with arterial hypertension and obstructive sleep apnea on cpap-therapy. Artery Res 3:173CrossRef

15.

Litvin A, Rogoza A, Chazova I, Sukmarova Z (2010) Reduction of BP and arterial stiffness in patients with severe obstructive sleep apnea and arterial hypertension on Ð¡ PAP-therapy. Am J Respir Crit Care Med 181:A2472

16.

Sukmarova Z, Litvin A, Rogoza A, Chazova I (2010) Influence of npap-therapy on arterial stiffness in patients with arterial hypertension II-III GR. and severe obstructive sleep apnea. J Hypertens 28:e536CrossRef

17.

Litvin AY, Sukmarova ZN, Elfimova EM, Aksenova AV, Galitsin PV, Rogoza AN, Chazova IE (2013) Effects of CPAP on “vascular” risk factors in patients with obstructive sleep apnea and arterial hypertension. Vasc Health Risk Manag 9:229–235. doi:10.2147/vhrm.s40231 CrossRefPubMedPubMedCentral

18.

Saito T, Saito T, Sugiyama S, Asai K, Yasutake M, Mizuno K (2010) Effects of long-term treatment for obstructive sleep apnea on pulse wave velocity. Hypertens Res 33:844–849. doi:10.1038/hr.2010.77 CrossRefPubMed

19.

Kartali N, Daskalopoulou E, Geleris P, Chatzipantazi S, Tziomalos K, Vlachogiannis E, Karagiannis A (2014) The effect of continuous positive airway pressure therapy on blood pressure and arterial stiffness in hypertensive patients with obstructive sleep apnea. Sleep Breath 18:635–640. doi:10.1007/s11325-013-0926-0 CrossRefPubMed

20.

Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327. doi:10.1016/j.jacc.2009.10.061 CrossRefPubMed

21.

Korcarz CE, Gepner AD, Peppard PE, Young TB, Stein JH (2010) The effects of sleep-disordered breathing on arterial stiffness are modulated by age. Sleep 33:1081–1085PubMedPubMedCentral

22.

Kohler M, Craig S, Nicoll D, Leeson P, Davies RJ, Stradling JR (2008) Endothelial function and arterial stiffness in minimally symptomatic obstructive sleep apnea. Am J Respir Crit Care Med 178:984–988. doi:10.1164/rccm.200805-717OC CrossRefPubMed

23.

Protogerou AD, Laaban JP, Czernichow S, Kostopoulos C, Lekakis J, Safar ME, Blacher J (2008) Structural and functional arterial properties in patients with obstructive sleep apnoea syndrome and cardiovascular comorbidities. J Hum Hypertens 22:415–422. doi:10.1038/sj.jhh.1002318 CrossRefPubMed

24.

Pack AI, Gislason T (2009) Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis 51:434–451. doi:10.1016/j.pcad.2009.01.002 CrossRefPubMed

25.

McNicholas WT (2009) Obstructive sleep apnea and inflammation. Prog Cardiovasc Dis 51:392–399. doi:10.1016/j.pcad.2008.10.005 CrossRefPubMed

26.

Lavie L, Lavie P (2009) Molecular mechanisms of cardiovascular disease in OSAHS: the oxidative stress link. Eur Respir J 33:1467–1484. doi:10.1183/09031936.00086608 CrossRefPubMed

27.

Cofta S, Wysocka E, Piorunek T, Rzymkowska M, Batura-Gabryel H, Torlinski L (2008) Oxidative stress markers in the blood of persons with different stages of obstructive sleep apnea syndrome. J Physiol Pharmacol 59(Suppl 6):183–190PubMed

28.

Lavie L (2009) Oxidative stress—a unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis 51:303–312. doi:10.1016/j.pcad.2008.08.003 CrossRefPubMed

29.

Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M (2003) Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 107:1129–1134CrossRefPubMed

30.

Alzoghaibi MA, Bahammam AS (2005) Lipid peroxides, superoxide dismutase and circulating IL-8 and GCP-2 in patients with severe obstructive sleep apnea: a pilot study. Sleep Breath 9:119–126. doi:10.1007/s11325-005-0022-1 CrossRefPubMed

31.

Shiina K, Tomiyama H, Takata Y, Yoshida M, Kato K, Saruhara H, Hashimura Y, Matsumoto C, Asano K, Usui Y, Yamashina A (2010) Effects of CPAP therapy on the sympathovagal balance and arterial stiffness in obstructive sleep apnea. Respir Med 104:911–916. doi:10.1016/j.rmed.2010.01.010 CrossRefPubMed

32.

Kohler M, Craig S, Pepperell JC, Nicoll D, Bratton DJ, Nunn AJ, Leeson P, Stradling JR (2013) CPAP improves endothelial function in patients with minimally symptomatic OSA: results from a subset study of the MOSAIC trial. Chest 144:896–902. doi:10.1378/chest.13-0179 CrossRefPubMed

33.

Tsioufis C, Thomopoulos K, Dimitriadis K, Amfilochiou A, Tousoulis D, Alchanatis M, Stefanadis C, Kallikazaros I (2007) The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J Hypertens 25:141–146. doi:10.1097/HJH.0b013e32801092c1 CrossRefPubMed

34.

Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Vasan RS, Mitchell GF (2012) Aortic stiffness, blood pressure progression, and incident hypertension. JAMA 308:875–881. doi:10.1001/2012.jama.10503 CrossRefPubMedPubMedCentral

Title: Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis
Authors: Xin Lin
Gongping Chen
Jiachao Qi
Xiaofang Chen
Jiangming Zhao
Qichang Lin
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 12/2016
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-016-3914-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2016

The eardrum bridge of traumatic tympanic membrane perforation

Squamous cell carcinoma of unknown primary tumor metastatic to neck nodes: role of elective irradiation

Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction

Application of xenogenic acellular dermal matrix in reconstruction of oncological hypopharyngeal defects

High relative density of lymphatic vessels predicts poor survival in tongue squamous cell carcinoma

Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center