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Purpose <p>While continuous positive airway pressure (CPAP) reduces cardiovascular risk in obstructive sleep apnea (OSA), its effects on renin–angiotensin–aldosterone system (RAAS) modulation remain controversial. This meta-analysis investigates CPAP's differential impacts on RAAS components and identifies responsive patient subgroups.</p> Methods <p>Sixteen studies were included in the systematic review and eight (231 patients) in the meta-analysis. Primary outcomes included plasma aldosterone concentration (PAC), plasma renin activity (PRA), and angiotensin II (AngII) changes. Subgroup analyses examined age, BMI, and CPAP duration thresholds, with meta-regression assessing moderating factors.</p> Results <p>CPAP significantly reduced PAC (d + of -0.72, 95% CI -1.39 to -0.05, <i>p</i> = 0.036), though statistical significance was attenuated in adjusted models, and improved daytime hemodynamics: systolic BP (d + -0.81), diastolic BP (d + -1.30), and heart rate (d + -1.61). Notably, patients &lt; 50&#xa0;years showed marked PAC reduction (d + -1.12, 95% CI -1.88 to -0.35), as did those with CPAP adherence ≥ 3&#xa0;months (d + -0.88, 95% CI -1.86 to 0.09). No significant changes occurred in PRA (<i>p</i> = 0.917), plasma renin concentration (<i>p</i> = 0.463), or AngII (<i>p</i> = 0.058) in the overall cohort. Meta-regression revealed no significant associations between age, BMI, or CPAP duration and RAAS changes (all <i>p</i> &gt; 0.05).</p> Conclusion <p>CPAP demonstrates selective RAAS modulation – significantly lowering PAC – alongside pronounced hemodynamic benefits, even though overall renin and AngII levels did not change significantly. Younger patients (&lt; 50&#xa0;years) and those maintaining ≥ 3&#xa0;months therapy show aldosterone responsiveness, suggesting duration-dependent physiological effects. These findings highlight CPAP's potential role in targeted RAAS modulation and underscore the need for personalized treatment strategies in OSA management.</p>

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Impact of continuous positive airway pressure therapy on renin–angiotensin–aldosterone system in obstructive sleep apnea: an updated systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Huai Heng Loh,
  • Waye Hann Kang,
  • Anne Yee,
  • Anselm Ting Su,
  • Mei Ching Yong,
  • Asri Said,
  • Huai Seng Loh,
  • Norlela Sukor

摘要

Purpose

While continuous positive airway pressure (CPAP) reduces cardiovascular risk in obstructive sleep apnea (OSA), its effects on renin–angiotensin–aldosterone system (RAAS) modulation remain controversial. This meta-analysis investigates CPAP's differential impacts on RAAS components and identifies responsive patient subgroups.

Methods

Sixteen studies were included in the systematic review and eight (231 patients) in the meta-analysis. Primary outcomes included plasma aldosterone concentration (PAC), plasma renin activity (PRA), and angiotensin II (AngII) changes. Subgroup analyses examined age, BMI, and CPAP duration thresholds, with meta-regression assessing moderating factors.

Results

CPAP significantly reduced PAC (d + of -0.72, 95% CI -1.39 to -0.05, p = 0.036), though statistical significance was attenuated in adjusted models, and improved daytime hemodynamics: systolic BP (d + -0.81), diastolic BP (d + -1.30), and heart rate (d + -1.61). Notably, patients < 50 years showed marked PAC reduction (d + -1.12, 95% CI -1.88 to -0.35), as did those with CPAP adherence ≥ 3 months (d + -0.88, 95% CI -1.86 to 0.09). No significant changes occurred in PRA (p = 0.917), plasma renin concentration (p = 0.463), or AngII (p = 0.058) in the overall cohort. Meta-regression revealed no significant associations between age, BMI, or CPAP duration and RAAS changes (all p > 0.05).

Conclusion

CPAP demonstrates selective RAAS modulation – significantly lowering PAC – alongside pronounced hemodynamic benefits, even though overall renin and AngII levels did not change significantly. Younger patients (< 50 years) and those maintaining ≥ 3 months therapy show aldosterone responsiveness, suggesting duration-dependent physiological effects. These findings highlight CPAP's potential role in targeted RAAS modulation and underscore the need for personalized treatment strategies in OSA management.