Abstract
Aim: We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM). Design: The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: “obstructive sleep apnea”, “sleep quality”, “non dipping”, “reduced nocturnal BP fall”, “circadian BP variation”, “night-time BP”, and “ambulatory blood pressure monitoring”. Results: Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0–90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0–65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07–1.89, p < 0.01). After the exclusion of patients with mild OSA, OR increased to 1.67 (CI: 1.21–2.28, p < 0.001). Conclusions: The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping.
Highlights
Ambulatory blood pressure monitoring (ABPM) provides the unique opportunity to assess circadian blood pressure (BP) variability [1]
The nocturnal BP fall is closely linked to the physiological reduction of the sympathetic nervous system during the night-time period, which results in a pronounced decrease in cardiac output, arterial resistances, and heart rate [3]
obstructive sleep-apnea syndrome (OSA), which is often associated with hypertension, obesity, diabetes, and metabolic syndrome, is a highly prevalent chronic condition in the general population, characterized by a marked stimulation of the sympathetic activity induced by recurrent nocturnal desaturation episodes [10]
Summary
Ambulatory blood pressure monitoring (ABPM) provides the unique opportunity to assess circadian blood pressure (BP) variability [1]. The nocturnal BP fall is closely linked to the physiological reduction of the sympathetic nervous system during the night-time period, which results in a pronounced decrease in cardiac output, arterial resistances, and heart rate [3]. The extent of day/night BP variations in population-based samples and, in general, hypertensive cohorts has been related to several factors such as age, ethnicity, intensity of diurnal physical activity, job stress, smoking habits, quality of sleep, seasonal influence, and co-morbidities [4,5,6]. OSA, which is often associated with hypertension, obesity, diabetes, and metabolic syndrome, is a highly prevalent chronic condition in the general population, characterized by a marked stimulation of the sympathetic activity induced by recurrent nocturnal desaturation episodes [10]
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