title: Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity.
abstract: OBJECTIVE
  We 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).
  
  
  METHODS
  Patient-level meta-analysis.
  
  
  METHODS
  N/A.
  
  
  METHODS
  968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials.
  
  
  METHODS
  Therapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  OSA 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.
authors.affiliation: Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA.
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Bakker
authors.affiliation: Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Edwards
authors.affiliation: Division of Translational Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA.
authors.forename: Shiva P
authors.initials: SP
authors.lastname: Gautam
authors.affiliation: Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston MA.
authors.forename: Sydney B
authors.initials: SB
authors.lastname: Montesi
authors.affiliation: Research Department, Sleep Division, Araba University, Basque Country University, Vitoria Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Durán-Cantolla
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.affiliation: Research Department, Sleep Division, Araba University, Basque Country University, Vitoria Spain.
authors.forename: Felipe Aizpuru
authors.initials: FA
authors.lastname: Barandiarán
authors.affiliation: Hospital Arnau de Vilanova, IRB Lleida, Respiratory Department, Lleida, Spain. CIBERes, Madrid, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Barbé
authors.affiliation: Hospital Arnau de Vilanova, IRB Lleida, Respiratory Department, Lleida, Spain. CIBERes, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Sánchez-de-la-Torre
authors.affiliation: Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston MA ; Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston MA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*
keywords: Patient-level meta-analysis; hypertension; lung; obstructive sleep apnea; positive airway pressure
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