2 obstructive sleep apnea treatments show similar reductions in blood pressure
Although there was no statistically significant difference in change in blood pressure between continuous positive airway pressure and mandibular advancement devices, the former had a considerably higher probability of having the strongest association with systolic blood pressure reduction.
Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) for sleep apnea were associated with similar reductions in blood pressure, an analysis found.
Researchers in Switzerland conducted a meta-analysis of 51 studies (4,888 patients) that compared CPAP and MADs to inactive controls such as placebo or no treatment and examined their associations with changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP).
Results appeared in the Dec. 1 Journal of the American Medical Association.
Of the studies, 44 compared CPAP with an inactive control (4,289 patients), 3 compared MADs with an inactive control (229 patients), 1 compared CPAP with MADs (126 patients), and 3 compared CPAP, MADs, and an inactive control (244 patients).
Compared with an inactive control, CPAP was associated with a reduction of 2.5 mm Hg in SBP (95% CI, 1.5 to 3.5 mm Hg; P<0.001) and of 2.0 mm Hg in DBP (95% CI, 1.3 to 2.7 mm Hg; P<0.001). A 1-hour-per-night increase in mean CPAP use was associated with an additional reduction in SBP of 1.5 mm Hg (95% CI, 0.8 to 2.3 mm Hg; P<0.001) and an additional reduction in DBP of 0.9 mm Hg (95% CI, 0.3 to 1.4 mm Hg; P=0.001). Compared with an inactive control, MADs were associated with a reduction of 2.1 mm Hg in SBP (95% CI, 0.8 to 3.4 mm Hg; P=0.002) and of 1.9 mm Hg in DBP (95% CI, 0.5 to 3.2 mm Hg; P=0.008). There was no significant difference between CPAP and MADs in change in SBP (−0.5 mm Hg; 95% CI, −2.0 to 1.0 mm Hg; P=0.55) or DBP (−0.2 mm Hg; 95% CI, −1.6 to 1.3 mm Hg; P=0.82).
The authors noted that even though there was no statistically significant difference in change in blood pressure between CPAP and MADs, CPAP had a considerably higher probability of having the strongest association with SBP reduction.
“The associations of both CPAP and MADs with DBP reduction were more similar,” the authors wrote, “however, the association of CPAP with reductions of both SBP and DBP is likely to be greater in patients using CPAP for longer periods at night or in those with higher baseline BP levels.”