Dataset Information

Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnancy: A Systematic Review and Meta-Analysis.

ABSTRACT:

Importance

Pregnancy may contribute to the development or exacerbation of obstructive sleep apnea (OSA) and increase the risk of gestational complications. Continuous positive airway pressure (CPAP) is the first-line and criterion standard treatment for OSA and is regarded as the most feasible choice during pregnancy. However, the association between CPAP therapy in pregnant women with OSA and reduced gestational complications remains inconclusive.

Objective

To investigate the association between CPAP therapy in pregnant women with OSA and the reduction of adverse hypertensive outcomes during gestation.

Data sources

Keyword searches of PubMed, Embase, and the Cochrane Database of Systematic Reviews and Clinical Trials were conducted from inception to November 5, 2023.

Study selection

Original studies reporting the treatment effect of CPAP use on lowering hypertension and preeclampsia risks in pregnant women with OSA were selected.

Data extraction and synthesis

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed in the reporting of reviews. Data were independently extracted by 2 authors. Random-effects model meta-analyses were performed and risk ratios (RRs) reported. Subgroup analysis, meta-regression based on age and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and publication bias assessment were also conducted.

Main outcome and measures

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

Results

Six original studies in 809 participants (mean age, 31.4 years; mean BMI, 34.0) were identified and systematically reviewed for meta-analysis. The pooled results showed significant differences between the intervention (CPAP use) and the control (non-CPAP use) groups in reducing the risk of gestational hypertension (RR, 0.65; 95% CI, 0.47-0.89; P = .008) and preeclampsia (RR, 0.70; 95% CI, 0.50-0.98; P = .04). Meta-regression revealed that patients' age (coefficient, -0.0190; P = .83) and BMI (coefficient, -0.0042; P = .87) were not correlated with reduction of risk of hypertension and preeclampsia.

Conclusions and relevance

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

SUBMITTER: Lee YC

PROVIDER: S-EPMC11322849 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnancy: A Systematic Review and Meta-Analysis.

Lee Yi-Chieh YC Chang Yun-Chen YC Tseng Liang-Wei LW Lin Wan-Ni WN Lu Chun-Ting CT Lee Li-Ang LA Fang Tuan-Jen TJ Cheng Wen-Nuan WN Li Hsueh-Yu HY

JAMA network open 20240801 8

<h4>Importance</h4>Pregnancy may contribute to the development or exacerbation of obstructive sleep apnea (OSA) and increase the risk of gestational complications. Continuous positive airway pressure (CPAP) is the first-line and criterion standard treatment for OSA and is regarded as the most feasible choice during pregnancy. However, the association between CPAP therapy in pregnant women with OSA and reduced gestational complications remains inconclusive.<h4>Objective</h4>To investigate the ass ...[more]

PMID: 39136943

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Project description:Background: Continuous positive airway pressure (CPAP) has been associated with a lower risk of treatment failure than high-flow nasal cannula (HFNC) in pediatric patients with respiratory distress and severe hypoxemia. However, the publication of new trials on children younger than 2 years warrants a review and updated meta-analysis of the evidence. Methods: We conducted a systematic search in the PubMed, Scopus, and Google scholar databases for randomized controlled trials (RCTs) in pediatric patients with acute respiratory distress that examined outcomes of interest by the two usual management modalities (CPAP and HFNC). We used pooled adjusted relative risks (RRs) to present the strength of association for categorical outcomes and weighted mean differences (WMDs) for continuous outcomes. Results: We included data from six articles in the meta-analysis. The quality of the studies was deemed good. Included studies had infants with either acute viral bronchiolitis or pneumonia. Compared to CPAP, HFNC treatment carried a significantly higher risk of treatment failure [RR, 1.45; 95% CI, 1.06 to 1.99; I 2 = 0.0%, n = 6]. Patients receiving HFNC had a lower risk of adverse events, mainly nasal trauma [RR, 0.30; 95% CI, 0.14 to 0.62; I 2 = 0.0%, n = 2] than the others. The risk of mortality [RR, 3.33; 95% CI, 0.95, 11.67; n = 1] and need for intubation [RR, 1.69; 95% CI, 0.97, 2.94; I 2 = 0.0%, n = 5] were statistically similar between the two management strategies; however, the direction of the pooled effect sizes is indicative of a nearly three times higher mortality and two times higher risk of intubation in those receiving HFNC. We found no statistically significant differences between the two management modalities in terms of modified woods clinical asthma score (M-WCAS; denoting severity of respiratory distress) and hospitalization length (days). Patients receiving HFNC had the time to treatment failure reduced by approximately 3 h [WMD, -3.35; 95% CI, -4.93 to -1.76; I 2 = 0.0%, n = 2] compared to those on CPAP. Conclusions: Among children with respiratory distress younger than 2 years, HFNC appears to be associated with higher risk of treatment failure and possibly, an increased risk of need for intubation and mortality. Adequately powered trials are needed to confirm which management strategy is better.

Project description:BackgroundThe efficacies of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) in neonatal respiratory distress syndrome (RDS) are controversial. The reasons for controversy may be the selection bias of research objects and the small sample size.MethodsLiterature retrieval was performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang and China Science Digital Library (CSDL) databases. Inclusion criteria: (I) literatures involving subjects who were newborns with RDS; (II) studies that had established both experimental and control groups; (III) the intervention measures of the experimental and control groups were NIPPV and NCPAP, respectively; (IV) the results included the incidence of intubation, bronchopulmonary dysplasia (BPD), or mortality; and (V) randomized controlled trials (RCTs). The chi-square test was applied for heterogeneity test. Publication bias assessment was conducted by funnel plot and Egger's test. The revised Cochrane risk of bias tool for individually randomized, parallel group trials (RoB2.0) was used to evaluate the risk of bias of the included RCT research.ResultsA total of 10 literatures were included for analysis, including 1,104 patients, 557 in the NIPPV group and 547 in the NCPAP group. Among the literatures, 2 literatures had low risk of bias, 2 literatures had high risk of bias, and the rest had uncertain risk of bias. Compared to NCPAP, NIPPV reduced the incidence of neonatal intubation in RDS [risk ratio (RR) =0.57, 95% confidence interval (CI): 0.46-0.71, Z=5.11, P<0.00001]. There was no statistically significant heterogeneity (P=0.13, I2=36%) or publication bias (P<0.05) among the studies. Compared with NCPAP, NIPPV reduced the incidence of BPD in RDS (RR =0.72, 95% CI: 0.57-0.91, Z=2.70, P=0.007). There was no statistically significant heterogeneity (P=0.10, I2=41%) or publication bias (P>0.05) among the studies. NIPPV reduced the neonatal mortality rate of RDS (RR =0.55, 95% CI: 0.31-0.97, Z=2.08, P=0.04). There was no statistically significant heterogeneity (P=0.20, I2=38%) or publication bias (P>0.05) among the studies.DiscussionCompared with NCPAP, NIPPV can reduce the incidence of intubation, BPD, and mortality. The conclusions need to be confirmed via high-quality RCTs.

Dataset Information

Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnancy: A Systematic Review and Meta-Analysis.

Importance

Objective

Data sources

Study selection

Data extraction and synthesis

Main outcome and measures

Results

Conclusions and relevance

Publications

Continuous Positive Airway Pressure Treatment and Hypertensive Adverse Outcomes in Pregnancy: A Systematic Review and Meta-Analysis.

Similar Datasets

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