Effect of CPAP therapy on BP in patients with OSA a worldwide individual patient data meta-analysis

The interaction between sleep disordered breathing, particularly obstructive sleep apnoea (OSA), and arterial hypertension has been well described in both cross sectional and longitudinal studies. [1–] Both morbidities are linked through several pathophysiological pathways that include the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, triggered by intermittent hypoxia and arousals from sleep induced by apnoeic events. [3–5] Nonetheless, the strength of this association is questioned by important confounding factors coexisting in patients with OSA, such as obesity. [6] Since the late 1980s, many randomised controlled trials (RCT) have assessed the effect of OSA therapies on blood pressure (BP). Results from these RCTs have been summarised in systematic reviews and meta-analyses, concluding for a modest reduction in systolic and diastolic BP. [7] This conclusion, however, is challenged by a large heterogeneity of the available studies, due to difference among studies in compliance to OSA treatment, different BP measuring methods, improper CPAP titration [8–9], and inclusion of patients with different OSA clinical characteristics. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of Interest: M. F. Pengo has nothing to disclose. Conflict of Interest: E. I. Schwarz reports grants from Löwenstein Medical AG, Philips, and LUNGE Zürich. Conflict of Interest: F. Barbé has nothing to disclose. Conflict of Interest: P. A. Cistulli reports grants or contracts from ResMed, ResMed Foundation, and SomnoMed for the provision of grant funds or equipment for investigator-initiated research, consulting fees from ResMed (paid to institution), and SomnoMed, Signifier Medical, Bayer, and Sunrise (paid to consultant), and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from SomnoMed (paid to speaker). Conflict of Interest: L. F. Drager reports grants from FAPESP (Brazilian Funding Agency) – grant 2019/23496-8, and consulting fees from ResMed (Consultant for real-world data on PAP telemonitoring). Conflict of Interest: C. Fava reports payment or honoraria for lectures, presentations, manuscript writing, or educational events from Menarini and Novartis. Conflict of Interest: F. D. Fuchs has nothing to disclose. Conflict of Interest: M. S. M. Ip reports grants from Li Ka Shing Foundation. Conflict of Interest: K. A. Loffler has nothing to disclose. Conflict of Interest: M. M. S. Lui has nothing to disclose. Conflict of Interest: M. Á. Martínez-García has nothing to disclose. Conflict of Interest: D. McEvoy has nothing to disclose. Conflict of Interest: Y. Peker has nothing to disclose. Conflict of Interest: C. L. Phillips has nothing to disclose. Conflict of Interest: T. Quinnell reports grants from the UK NIHR for the PAPMAT study, with payments to their institution only. They received £250 for an educational talk on sleep apnoea at Cambridge University Medical School (October 2022, fee not yet paid). They had a consulting agreement with Jazz Pharma UK Ltd from February 10 to March 31, 2022, which included services in return for registration, accommodation, travel, and subsistence at the World Sleep Conference in Rome. T. Quinnell is the President and then Past President of the British Sleep Society (unpaid), and the Chair of the Sleep Apnoea Specialty Advisory Group for the British Thoracic Society (December 2022 - ongoing). They are also the Director of their own company, TNQ Medical Ltd, where they conduct private medical work. Conflict of Interest: D. Soranna has nothing to disclose. Conflict of Interest: J. Steier has nothing to disclose. Conflict of Interest: J. R. Stradling has nothing to disclose. Conflict of Interest: A. Zambon has nothing to disclose. Conflict of Interest: G. Parati has nothing to disclose.