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Q&As

Not All OSA Patients See Same Cardiovascular Benefits From CPAP

Martino Pengo, MD, PhD.
Martino Pengo, MD, PhD.

Continuous positive airway pressure (CPAP) therapy is a first-line treatment for cardiovascular patients living with obstructive sleep apnea (OSA), but this one-size-fits-all approach may be less effective than realized.

In this interview, Martino Pengo, MD, PhD, discusses his global meta-analysis on CPAP therapy's effects on blood pressure in OSA patients. Analyzing data from 48 randomized control trials, the study reveals that CPAP may not affect hypertension patients in the same way across the board. Dr Pengo discusses the clinical implications of these findings, explains how they challenge traditional assumptions, and explores future research directions to help personalize CPAP therapy for optimal hypertension management in OSA.

Interested readers can find the original study, "Effect of CPAP therapy on blood pressure in patients with obstructive sleep apnoea: a worldwide individual patient data meta-analysis" published in European Respiratory Journal here.

For more expert insights, visit the Sleep Disorders Excellence Forum right here on Pulmonology Learning Network.


Pulmonology Learning Network: Could you give us a brief overview of the study subject, design, and most significant findings?

Martino Pengo, MD: This study is a global individual patient data (IPD) meta-analysis conducted by the ANDANTE research group. Our primary objective was to evaluate the impact of continuous positive airway pressure (CPAP) therapy on blood pressure in patients with obstructive sleep apnea (OSA).

We analyzed data from 48 randomized controlled trials (RCTs), encompassing a total of 9,434 patients. Blood pressure measurements were assessed both in clinical settings and through 24-hour ambulatory monitoring. Regarding the study design, we included RCTs that compared CPAP therapy with a control group, either placebo or no CPAP. The individual patient data were pooled and analyzed using a hierarchical linear mixed model.

As for our main findings, we observed a significant reduction in blood pressure among patients with uncontrolled hypertension at baseline. However, in individuals with normal or well-controlled blood pressure, CPAP therapy did not produce a meaningful impact on blood pressure levels. Additionally, a more pronounced reduction in 24-hour blood pressure was seen in patients under the age of 60.

PLM: Do your findings align with or challenge traditional assumptions about the relationship between cardiovascular disease and OSA? Why or why not?

Dr Pengo: Our findings challenge the traditional assumption that CPAP therapy universally lowers blood pressure in all patients with OSA. Previous studies may have underestimated the blood pressure-lowering effects of CPAP because they included heterogeneous populations with varying levels of baseline blood pressure and hypertension control. Our meta-analysis clarifies that the benefits of CPAP therapy are primarily seen in patients with uncontrolled hypertension. These results suggest that the effectiveness of CPAP in reducing blood pressure is not uniform but rather depends on an individual’s baseline condition.

PLM: What are some of the clinical implications of your findings when it comes to managing arterial hypertension associated with OSA?

Dr Pengo: These findings have important clinical implications for managing arterial hypertension in patients with OSA. First, it is crucial to assess a patient’s blood pressure profile when considering CPAP therapy. Our results indicate that CPAP should be particularly recommended as an adjunct to antihypertensive treatment in individuals with uncontrolled hypertension.

For normotensive patients, or those with well-controlled hypertension, CPAP may not provide additional benefits in terms of blood pressure reduction. In such cases, its role in lowering cardiovascular risk remains uncertain.

Furthermore, our findings emphasize the importance of early diagnosis and treatment of OSA, particularly in younger patients, as earlier intervention may lead to greater reductions in blood pressure.

PLM: Which new research questions and directions has conducting this research raised?

Dr Pengo: Our study has opened several new avenues for research. One key area is identifying additional predictive factors for blood pressure reduction with CPAP therapy, such as the severity of nocturnal hypoxemia. Future studies should explore more specific markers of nocturnal hypoxia, such as the hypoxic load, to better understand the mechanisms linking CPAP therapy and blood pressure regulation.

Another critical research direction involves assessing the long-term effects of CPAP therapy on blood pressure, particularly in patients with uncontrolled hypertension, to determine whether sustained benefits persist over time.

Lastly, there is a growing need to personalize CPAP therapy by identifying subgroups of patients who are most likely to benefit from treatment. Tailoring interventions based on individual characteristics could enhance the effectiveness of CPAP in managing hypertension associated with OSA.


Martino Pengo, MD, PhD, is an assistant arofessor at the University of Milano-Bicocca. He obtained his medical degree from the University of Padua, where he also completed his training in Internal Medicine. During his residency, he began conducting clinical research in cardiovascular prevention and arterial hypertension. He then moved to the UK for a fellowship at King’s College London, where he expanded his research and clinical focus to the relationship between sleep disorders and cardiovascular disease. He successfully obtained the Expert Somnologist certification from the European Society of Sleep Research. In 2016, Dr Pengo completed an International PhD program on “Arterial Hypertension and Vascular Biology.” Upon returning to Italy, he was appointed consultant physician and senior researcher at the Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano in Milan.


 

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