Sleep surgery for obstructive sleep apnea may decrease blood pressure

1. In this systematic review and meta-analysis, surgeries for sleep apnea showed improvements in obstructive sleep apnea symptoms as well as blood pressure.

2. Furthermore, there were significant decreases in blood pressure in both eastern and western countries, with no significant differences between the two demographic groups.

Evidence Rating Level: 2 (Good)

Obstructive sleep apnea (OSA) can obstruct the airway during sleep and is associated with increased blood pressure (BP). Continuous positive airway pressure (CPAP) is an effective first-line treatment that can also reduce BP; however, in a selected patient group, surgical intervention is necessary for OSA treatment. Surgery type include uvulopalatopharnygoplasty, and maxillomandibular advancement. This study’s objective was to evaluate the effects of surgery for the treatment of OSA on BP reduction.

This systematic review and meta-analysis used a literature search of OSA, sleep surgery, and BP terms. The study was conducted under PRISMA guidelines. Studies were included based on age criteria, polysomnography confirmed OSA, having surgery for OSA, and pre- and post- BP monitoring. Case reports, letters to the editor, and abstracts were excluded. Quality assessment was done using the Newcastle-Ottawa Scale. 4041 records were screened, and 3226 articles were reviewed by abstract and title. 61 studies were incorporated in full-text review.

26 studies were included in the review and meta-analysis. 22 studies were case series studies, while the remainder were case-control and randomized controlled trial studies. Study results showed a significant reduction in objective (apnea-hypopnea index) and subjective (Epworth Sleepiness Scale) markers of sleep apnea after surgical intervention. Furthermore, there was an overall mean reduction in systolic BP (5.6 mHg) and diastolic BP (3.9 mmHg) after surgical intervention. There were no differences in mean changes to BP between studies completed in eastern versus western countries. Subgroup analysis showed greater BP changes with greater reduction in objective OSA measures post-surgery. However, this study was limited due to use of primarily case series studies and there was no comparison between those having surgery and a control group. Nonetheless, this study was the first meta-analysis of OSA surgery and its effect on BP reduction.

 Click to read the study in Sleep Medicine Reviews

Image: PD

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