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Impact of CPAP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials

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Abstract

Purpose

This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA.

Methods

The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool.

Results

Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, − 1.96 (95% confidence interval (CI) − 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, − 0.44 (95% confidence interval (CI) − 0.76 to − 0.12), p = 0.00).

Conclusion

CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.

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Funding

Fundação de Amparo à Pesquisa do Estado de Pernambuco and Conselho Nacional de Desenvolvimento Científico e Tecnológico.

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Authors and Affiliations

  1. Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil

    Sintya T. Chalegre, Ozeas L. Lins-Filho, Thais C. Lustosa, Marcus V. França, Tarcya L. G. Couto & Rodrigo P. Pedrosa

  2. Hypertension Unit, Heart Institute (InCor) and Renal Division, University Hospital, Faculdade de Medicina, University of São Paulo, Sao Paulo, Brazil

    Luciano F. Drager

  3. Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University Hospital, University of São Paulo, Sao Paulo, Brazil

    Geraldo Lorenzi-Filho

  4. Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil

    Marcio S. Bittencourt

  5. Hospital Israelita Albert Einstein & Faculdade Israelita de Ciências da Saúde Albert Einstein, Sao Paulo, Brazil

    Marcio S. Bittencourt

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  1. Sintya T. Chalegre
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  2. Ozeas L. Lins-Filho
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  3. Thais C. Lustosa
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  6. Luciano F. Drager
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  8. Marcio S. Bittencourt
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Correspondence to Ozeas L. Lins-Filho.

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Attachment’ Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) Statement. (DOC 64 kb)

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Risk of bias analysis. (DOCX 20 kb)

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Chalegre, S.T., Lins-Filho, O.L., Lustosa, T.C. et al. Impact of CPAP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials. Sleep Breath 25, 1195–1202 (2021). https://doi.org/10.1007/s11325-020-02226-7

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  • DOI: https://doi.org/10.1007/s11325-020-02226-7

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