BACKGROUND: CPAP is considered the therapy of choice for OSA, but the extent to which it can reduce BP is still under debate. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to quantify the effect size of the reduction of BP by CPAP therapy compared with other passive (sham CPAP, tablets of placebo drug, conservative measures) or active (oral appliance, antihypertensive drugs) treatments. METHODS: We searched four different databases (Medline, Embase, Web of Science, and the Cochrane Library) with specific search terms and selection criteria. RESULTS: From 1,599 articles, we included 31 RCTs that compared CPAP with either passive or active treatment. In a random-effects meta-analysis versus passive treatment (29 RCTs, 1,820 subjects), we observed a mean +/- SEM net difference in systolic BP of 2.6 +/- 0.6 mmHg and in diastolic BP of 2.0 +/- 0.4 mmHg, favoring treatment with CPAP (p < 0.001). Among studies using 24-h ambulatory BP monitoring that presented data on daytime and nighttime periods, the mean difference in systolic and diastolic BP was, respectively, 2.2 +/- 0.7 and 1.9 +/- 0.6 mmHg during daytime and 3.8 +/- 0.8 and 1.8 +/- 0.6 mmHg during nighttime. In meta-regression analysis, a higher baseline apnea/hypopnea index was associated with a greater mean net decrease in systolic BP (beta +/- SE, 0.08 +/- 0.04). There was no evidence of publication bias, and heterogeneity was mild (I2, 34% to 36%). CONCLUSIONS: Therapy with CPAP significantly reduces BP in patients with OSA but with a low effect size. Patients with frequent apneic episodes may benefit the most from CPAP.

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