CPAP Treatment and Hypertensive Adverse Outcomes in Pregnancy: Daily Dose

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Last week, we reported on a study published in JAMA Network Open that examined the association between continuous positive airway pressure (CPAP) therapy in pregnant women with obstructive sleep apnea (OSA) and the reduction of adverse hypertensive outcomes during gestation.

The study

Researched conducted keyword searches of PubMed, Embase, and the Cochrane Database of Systematic Reviews and Clinical Trials and identified 46 articles of which 6 remained for the meta-analysis after applying the study's inclusion criteria: 1) pregnant women with OSA confirmed by polysomnography or home sleep test, 2) treatment with CPAP, 3) clearly defined experimental and control groups, and 4) outcome measurements that included risk of composite hypertensive outcomes (eg, gestational hypertension or preeclampsia).

The 6 studies included 809 women (mean age 31.4 years, mean BMI 34 kg/m²). Events for hypertensive disorder of pregnancy (ie, gestational hypertension, preeclampsia) were reported in all; intervention groups were treated with CPAP, control groups with standard of care for pregnant women.

The primary outcome was the risk ratio (RR) of gestational hypertension and preeclampsia between pregnant women with OSA receiving CPAP treatment and those who did not receive CPAP therapy.

The findings

The differences in risk between the intervention and control groups were statistically significant, with pooled results revealing a reduction in RR of hypertension of 0.65 (95% CI, 0.47-0.89; P = .008) and of preeclampsia of 0.70 (95% CI, 0.50-0.98; P = .04). After metaregression analysis, there was no correlation between participant age (coefficient, −0.0190; P = .83) and BMI (coefficient, −0.0042; P = .87) with reduction of risk for the composite outcome.

Authors' comment

"These findings suggest that implementing CPAP treatment in pregnant women with OSA may reduce the risk of gestational hypertension and preeclampsia."

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