THE EFFECT OF CPAP ON HYPERTENSION IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A LITERATURE REVIEW

Sylwia Wiktoria Kolano; Maksym Sikora; Jakub Nowak; Michael Platschek; Klaudia Dybalska; Julia Kosmulska; Mateusz Kęska; Anna Barbara Tuleja; Michał Drabik; Karol Józef Szkarłat

doi:10.31435/ijitss.4(48).2025.4256

Authors

Sylwia Wiktoria Kolano Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Kraków, Kraków, Poland https://orcid.org/0009-0000-1180-1135
Maksym Sikora Hospital of the Brothers of St. John of God, Kraków, Poland https://orcid.org/0009-0008-4495-7732
Jakub Nowak Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Kraków, Kraków, Poland https://orcid.org/0009-0003-7097-0635
Michael Platschek Blessed Marta Wiecka Hospital in Bochnia, Bochnia, Poland https://orcid.org/0009-0008-9085-4531
Klaudia Dybalska Brzeziny Specialist Hospital, Brzeziny, Poland https://orcid.org/0009-0006-9900-0167
Julia Kosmulska University Hospital in Wroclaw (USK), Wrocław, Poland https://orcid.org/0009-0000-8770-3793
Mateusz Kęska 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0000-0003-0712-7613
Anna Barbara Tuleja University Hospital in Wroclaw (USK), Wrocław, Poland https://orcid.org/0009-0003-9185-9493
Michał Drabik 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0004-0198-4926
Karol Józef Szkarłat Medical University of Silesia in Katowice, Faculty of Medical Sciences in Katowice, Katowice, Poland https://orcid.org/0009-0004-2889-8382

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4256

Keywords:

OSA, CPAP, Hypertension, Obstructive Sleep Apnea, Continuous Positive Airway Pressure, Hypertension, Ambulatory Blood Pressure Monitoring

Abstract

Obstructive sleep apnea (OSA) is a chronic condition characterized by recurrent episodes of upper airway obstruction during sleep, leading to intermittent hypoxia, sympathetic nervous system activation, and blood pressure dysregulation. Numerous studies have confirmed the frequent coexistence of OSA and hypertension, making this association a significant clinical and public health concern. The aim of this review was to assess the effect of CPAP (Continuous Positive Airway Pressure) therapy on blood pressure in different groups of patients with obstructive sleep apnea, based on current scientific data. The review included publications from 2015 to 2025, available in the PubMed database, regarding randomized controlled trials and meta-analyses assessing the effect of CPAP on blood pressure. A total of 15 randomized controlled trials and meta-analyses were included in the analysis. CPAP therapy remains the gold standard for OSA treatment and can be an effective adjunct to blood pressure control, particularly in patients with resistant hypertension. However, treatment effectiveness depends on adherence to recommendations and appropriate patient selection. Further research should focus on assessing the long-term effects of CPAP, identifying patient phenotypes that best respond to therapy, and developing treatment strategies in combination with antihypertensive pharmacotherapy.

References

Ahmed, A. M., Nur, S. M., & Xiaochen, Y. (2023). Association between obstructive sleep apnea and resistant hypertension: Systematic review and meta-analysis. Frontiers in Medicine, 10, 1200952. https://doi.org/10.3389/fmed.2023.1200952

American Academy of Sleep Medicine. (2023). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (Version 3.0). American Academy of Sleep Medicine. https://aasm.org/clinical-resources/scoring-manual/

Bangash, A., Wajid, F., Poolacherla, R., Mim, F. K., & Rutkofsky, I. H. (2020). Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association. Cureus. https://doi.org/10.7759/cureus.8241

Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S. M., Morrell, M. J., Nunez, C. M., Patel, S. R., Penzel, T., Pépin, J.-L., Peppard, P. E., Sinha, S., Tufik, S., Valentine, K., & Malhotra, A. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. The Lancet Respiratory Medicine, 7(8), 687–698. https://doi.org/10.1016/S2213-2600(19)30198-5

Bratton, D. J., Gaisl, T., Schlatzer, C., & Kohler, M. (2015). Comparison of the effects of continuous positive airway pressure and mandibular advancement devices on sleepiness in patients with obstructive sleep apnoea: A network meta-analysis. The Lancet. Respiratory Medicine, 3(11), 869–878. https://doi.org/10.1016/S2213-2600(15)00416-6

Chen, Q., Cheng, Y.-B., Shen, M., Yin, B., Yi, H.-H., Feng, J., Li, M., Li, Q.-Y., Li, Y., & Wang, J.-G. (2020). A randomized controlled trial on ambulatory blood pressure lowering effect of CPAP in patients with obstructive sleep apnea and nocturnal hypertension. Blood Pressure, 29(1), 21–30. https://doi.org/10.1080/08037051.2019.1686343

Elbadawi, A., Elgendy, I. Y., Shnoda, M., Abuzaid, A. S., Barssoum, K., Gouda, M., Megaly, M., Bansal, A., Gulati, M., & Jneid, H. (2021). Impact of continuous positive airway pressure ventilation on cardiovascular outcomes among patients with obstructive sleep apnea: A meta-analysis of randomized trials. American Heart Journal Plus: Cardiology Research and Practice, 11, 100056. https://doi.org/10.1016/j.ahjo.2021.100056

Heinzer, R., Vat, S., Marques-Vidal, P., Marti-Soler, H., Andries, D., Tobback, N., Mooser, V., Preisig, M., Malhotra, A., Waeber, G., Vollenweider, P., Tafti, M., & Haba-Rubio, J. (2015). Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. The Lancet Respiratory Medicine, 3(4), 310–318. https://doi.org/10.1016/S2213-2600(15)00043-0

Hoyos, C. M., Yee, B. J., Wong, K. K., Grunstein, R. R., & Phillips, C. L. (2015). Treatment of Sleep Apnea With CPAP Lowers Central and Peripheral Blood Pressure Independent of the Time-of-Day: A Randomized Controlled Study. American Journal of Hypertension, 28(10), 1222–1228. https://doi.org/10.1093/ajh/hpv023

Jin, Z.-N., & Wei, Y.-X. (2016). Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system. Journal of Geriatric Cardiology: JGC, 13(4), 333–343. https://doi.org/10.11909/j.issn.1671-5411.2016.03.020

Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(03), 479–504. https://doi.org/10.5664/jcsm.6506

Khamsai, S., Mahawarakorn, P., Limpawattana, P., Chindaprasirt, J., Sukeepaisarnjaroen, W., Silaruks, S., Senthong, V., Sawunyavisuth, B., & Sawanyawisuth, K. (2021). Prevalence and factors correlated with hypertension secondary from obstructive sleep apnea. Multidisciplinary Respiratory Medicine, 16(1), 777. https://doi.org/10.4081/mrm.2021.777

Kou, C., Zhao, X., Lin, X., Fan, X., Wang, Q., & Yu, J. (2022). Effect of different treatments for obstructive sleep apnoea on blood pressure. Journal of Hypertension, 40(6), 1071–1084. https://doi.org/10.1097/HJH.0000000000003131

Kwon, Y., Tzeng, W. S., Seo, J., Logan, J. G., Tadic, M., Lin, G.-M., Martinez-Garcia, M. A., Pengo, M., Liu, X., Cho, Y., Drager, L. F., Healy, W., & Hong, G.-R. (2024). Obstructive sleep apnea and hypertension; critical overview. Clinical Hypertension, 30(1), 19. https://doi.org/10.1186/s40885-024-00276-7

Labarca, G., Schmidt, A., Dreyse, J., Jorquera, J., Enos, D., Torres, G., & Barbe, F. (2021). Efficacy of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH): Systematic review and meta-analysis. Sleep Medicine Reviews, 58, 101446. https://doi.org/10.1016/j.smrv.2021.101446

Lee, E.-J., & Kim, S. J. (2025). Association of Obstructive Sleep Apnea and Uncontrolled Hypertension in the Middle Aged 40-59 in Korean Population. Journal of Korean Medical Science, 40(24), e129. https://doi.org/10.3346/jkms.2025.40.e129

Lei, Q., Lv, Y., Li, K., Ma, L., Du, G., Xiang, Y., & Li, X. (2017). Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: A systematic review and meta-analysis of six randomized controlled trials. Jornal Brasileiro De Pneumologia: Publicacao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia, 43(5), 373–379. https://doi.org/10.1590/S1806-37562016000000190

Liu, L., Cao, Q., Guo, Z., & Dai, Q. (2016). Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials. The Journal of Clinical Hypertension, 18(2), 153–158. https://doi.org/10.1111/jch.12639

Loh, H. H., Tay, S. P., Koa, A. J., Yong, M. C., Said, A., Chai, C. S., Malik, N. M. A., Su, A. T., Tang, B. B. C., Tan, F. H. S., Azizan, E. A., & Sukor, N. (2025). Hypertension in obstructive sleep apnea: The hidden role of renin–angiotensin–aldosterone system dysregulation. Tropical Medicine and Health, 53(1), 62. https://doi.org/10.1186/s41182-025-00742-4

Lombardi, C., Pengo, M. F., & Parati, G. (2018). Systemic hypertension in obstructive sleep apnea. Journal of Thoracic Disease, 10(Suppl 34), S4231–S4243. https://doi.org/10.21037/jtd.2018.12.57

McEvoy, R. D., Antic, N. A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., Mediano, O., Chen, R., Drager, L. F., Liu, Z., Chen, G., Du, B., McArdle, N., Mukherjee, S., Tripathi, M., Billot, L., Li, Q., Lorenzi-Filho, G., Barbe, F., … SAVE Investigators and Coordinators. (2016). CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. The New England Journal of Medicine, 375(10), 919–931. https://doi.org/10.1056/NEJMoa1606599

Muxfeldt, E. S., Margallo, V., Costa, L. M. S., Guimarães, G., Cavalcante, A. H., Azevedo, J. C. M., de Souza, F., Cardoso, C. R. L., & Salles, G. F. (2015). Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: A randomized controlled trial. Hypertension (Dallas, Tex.: 1979), 65(4), 736–742. https://doi.org/10.1161/HYPERTENSIONAHA.114.04852

Orrù, G., Storari, M., Scano, A., Piras, V., Taibi, R., & Viscuso, D. (2020). Obstructive Sleep Apnea, oxidative stress, inflammation and endothelial dysfunction-An overview of predictive laboratory biomarkers. European Review for Medical and Pharmacological Sciences, 24(12), 6939–6948. https://doi.org/10.26355/eurrev_202006_21685

Patil, S. P., Ayappa, I. A., Caples, S. M., Kimoff, R. J., Patel, S. R., & Harrod, C. G. (2019). Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 15(02), 335–343. https://doi.org/10.5664/jcsm.7640

Pengo, M. F., Schwarz, E. I., Barbé, F., Cistulli, P. A., Drager, L. F., Fava, C., Fuchs, F. D., Ip, M. S. M., Loffler, K. A., Lui, M. M. S., Martínez-García, M. Á., McEvoy, D., Peker, Y., Phillips, C. L., Quinnell, T., Soranna, D., Steier, J., Stradling, J. R., Zambon, A., … ANDANTE collaborators. (2025). Effect of CPAP therapy on blood pressure in patients with obstructive sleep apnoea: A worldwide individual patient data meta-analysis. The European Respiratory Journal, 65(1), 2400837. https://doi.org/10.1183/13993003.00837-2024

Pépin, J. L., Tamisier, R., Baguet, J. P., Lepaulle, B., Arbib, F., Arnol, N., Timsit, J. F., & Lévy, P. (2016). Fixed-pressure CPAP versus auto-adjusting CPAP: Comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial. Thorax, 71(8), 726–733. https://doi.org/10.1136/thoraxjnl-2015-207700

Peracaula, M., Torres, D., Poyatos, P., Luque, N., Rojas, E., Obrador, A., Orriols, R., & Tura-Ceide, O. (2022). Endothelial Dysfunction and Cardiovascular Risk in Obstructive Sleep Apnea: A Review Article. Life, 12(4), 537. https://doi.org/10.3390/life12040537

Prabhakar, N. R. (2016). Carotid body chemoreflex: A driver of autonomic abnormalities in sleep apnoea. Experimental Physiology, 101(8), 975–985. https://doi.org/10.1113/EP085624

Senaratna, C. V., Perret, J. L., Lodge, C. J., Lowe, A. J., Campbell, B. E., Matheson, M. C., Hamilton, G. S., & Dharmage, S. C. (2017). Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews, 34, 70–81. https://doi.org/10.1016/j.smrv.2016.07.002

Sforza, E., & Roche, F. (2016). Chronic intermittent hypoxia and obstructive sleep apnea: An experimental and clinical approach. Hypoxia (Auckland, N.Z.), 4, 99–108. https://doi.org/10.2147/HP.S103091

Shang, W., Zhang, Y., Liu, L., Chen, F., Wang, G., & Han, D. (2022). Benefits of continuous positive airway pressure on blood pressure in patients with hypertension and obstructive sleep apnea: A meta-analysis. Hypertension Research, 45(11), 1802–1813. https://doi.org/10.1038/s41440-022-00954-9

Shiina, K. (2024). Obstructive sleep apnea -related hypertension: A review of the literature and clinical management strategy. Hypertension Research, 47(11), 3085–3098. https://doi.org/10.1038/s41440-024-01852-y

Stansbury, R. C., & Strollo, P. J. (2015). Clinical manifestations of sleep apnea. Journal of Thoracic Disease, 7(9), E298–E310. https://doi.org/10.3978/j.issn.2072-1439.2015.09.13

Tan, B. K. J., Teo, Y. H., Tan, N. K. W., Yap, D. W. T., Sundar, R., Lee, C. H., See, A., & Toh, S. T. (2022). Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: A systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 18(5), 1427–1440. https://doi.org/10.5664/jcsm.9772

Turnbull, C. D. (2018). Intermittent hypoxia, cardiovascular disease and obstructive sleep apnoea. Journal of Thoracic Disease, 10(S1), S33–S39. https://doi.org/10.21037/jtd.2017.10.33

Zhao, Y. Y., Wang, R., Gleason, K. J., Lewis, E. F., Quan, S. F., Toth, C. M., Song, Y., Morrical, M., Rueschman, M., Mittleman, M. A., & Redline, S. (2022). Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: A randomized controlled trial. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 18(8), 1899–1907. https://doi.org/10.5664/jcsm.10012