Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

Area of Science:

• Cardiology
• Sleep Medicine
• Public Health

Background:

• Obstructive sleep apnea (OSA) is linked to cardiovascular issues.
• A reduced nocturnal blood pressure (BP) fall, known as non-dipping (ND), is associated with increased cardiovascular risk.
• Previous studies suggest a connection between OSA and ND, but comprehensive meta-analyses are needed.

Purpose of the Study:

• To conduct a meta-analysis examining the prevalence of the non-dipping (ND) pattern in patients with obstructive sleep apnea (OSA).
• To assess the association between OSA and the risk of ND using 24-hour ambulatory blood pressure monitoring (ABPM) data.
• To synthesize existing evidence on the relationship between OSA and impaired BP dipping patterns.

Main Methods:

• A systematic literature search was performed across PubMed, OVID-MEDLINE, and Cochrane CENTRAL up to April 2019.
• Studies involving patients with OSA and controls, reporting ND prevalence via ABPM, were included.
• Meta-analysis techniques were employed to pool data from 14 studies, including 1562 OSA patients and 957 controls.

Main Results:

• The prevalence of ND in OSA patients ranged from 36.0% to 90.0%, and in controls from 33.0% to 69.0%.
• The overall pooled prevalence of ND in the OSA population was 59.1%.
• OSA significantly increased the risk of ND (Odds Ratio = 1.47; 95% CI: 1.07-1.89). This risk was higher (OR = 1.67) when mild OSA cases were excluded.

Conclusions:

• Obstructive sleep apnea substantially increases the likelihood of adopting a non-dipping blood pressure pattern.
• The non-dipping pattern, more prevalent in OSA patients, is linked to elevated cardiovascular risk compared to normal BP dipping.
• This meta-analysis reinforces the importance of recognizing OSA as a significant risk factor for impaired nocturnal BP regulation.