title: Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.
abstract: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension (HTN). Increasing evidence from animal and human studies suggests that HTN exacerbates OSA. We performed a systematic review and meta-analysis of studies evaluating the effect of anti-hypertensive medications on the severity of OSA.
  
  
  
  A literature search of PubMed and Embase was done using search concepts of OSA, HTN, and drug classes used to treat HTN. Studies that reported changes in the severity of OSA objectively by using apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) were included. Pooled mean difference estimates were calculated. Tests for heterogeneity, publication bias, and subgroup sensitivity analysis were conducted.
  
  
  
  Of 27,376 studies screened, only 11 met inclusion criteria, including 5 randomized controlled trials and 6 single-arm prospective trials. The pooled mean difference estimate (95% confidence interval [CI]), based on a random-effects model, was -5.69 (95% CI -10.74 to -0.65), consistent with an overall decrease in AHI or RDI attributable to antihypertensive medications. The effect size was even more pronounced, -14.52 (95% CI -25.65 to -3.39), when only studies using diuretics were analyzed. There was no significant heterogeneity or publication bias among the studies. Meta-regression indicated neither age, baseline AHI, nor change in systolic/diastolic blood pressure influenced the results.
  
  
  
  Collectively, findings from these relatively small, short-term studies tend to support the contention that treatment with antihypertensive agents confers a statistically significant, albeit small, reduction in the severity of OSA, which may be more pronounced with the use of diuretics.
authors.affiliation: Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Khurshid
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yabes
authors.affiliation: Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Weiss
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM.
authors.forename: Sushma
authors.initials: S
authors.lastname: Dharia
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM.
authors.forename: Lee
authors.initials: L
authors.lastname: Brown
authors.affiliation: Nephrology Division, Department of Internal Medicine, University of New Mexico, Albuquerque, NM.
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.affiliation: Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Jhamb
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology*
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive medications; hypertension; obstructive sleep apnea