From Cause to Treatment: Obstructive Sleep Apnoea as a Driver of Hypertension and a Target for Prevention

Q: What is the clinical evidence from this study?

Study design: Review. Population: Obstructive sleep apnoea and hypertension. Intervention: Continuous positive airway pressure (CPAP) and alternative OSA therapies (mandibular advancement devices, weight management, pharmacotherapy). Primary outcome: Blood pressure reduction and incident hypertension risk.

Q: What does this research mean for the field?

CPAP therapy reduces the risk of incident hypertension by nearly 30% in patients with obstructive sleep apnoea, while mandibular advancement devices show non-inferior 24-hour blood pressure reductions driven by higher patient compliance. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Niamh Holmes

doi:10.33590/emjrespir/6cggvlyl

October 20, 2026EMJ RespiratoryOpen Access

From Cause to Treatment: Obstructive Sleep Apnoea as a Driver of Hypertension and a Target for Prevention

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Why the study?

A higher proportion of patients with obstructive sleep apnoea experience hypertension than in the general population, motivating this session examining their association and role as a target for prevention.

Do obstructive sleep apnoea therapies (CPAP, mandibular advancement devices, weight loss, and pharmacotherapy) improve blood pressure control and prevent hypertension in patients with obstructive sleep apnoea?

Key Points

To review the pathophysiological mechanisms linking obstructive sleep apnoea to hypertension, evaluate blood pressure outcomes across existing and emerging therapies, and identify biomarkers for personalized management.
Summary of an expert scientific session presented at the European Respiratory Society (ERS) Congress 2026 in Barcelona, Spain.
Synthesized findings from mechanistic investigations, meta-analyses, and clinical trials examining continuous positive airway pressure, oral appliances, weight loss, pharmacotherapies, and 24-hour ambulatory blood pressure monitoring.
In sleep clinic cohorts with obstructive sleep apnoea (apnoea-hypopnea index ≥5/h), 40–45% develop hypertension, 60% develop nocturnal hypertension or non-dipping blood pressure, and 10–20% experience resistant hypertension.
The ANDANTE meta-analysis of 9,434 patients across 36 randomized trials showed continuous positive airway pressure reduces blood pressure specifically when uncontrolled, and long-term therapy is associated with an almost 30% reduction in incident hypertension risk.
In the CRESCENT study, mandibular advancement devices produced greater 24-hour blood pressure reductions at 6 months than continuous positive airway pressure, with nearly 60% of patients using oral devices for over 6 hours nightly compared to 23% with positive airway pressure.

Structured PICO

Do obstructive sleep apnoea therapies (CPAP, mandibular advancement devices, weight loss, and pharmacotherapy) improve blood pressure control and prevent hypertension in patients with obstructive sleep apnoea?

P

Population

Patients with obstructive sleep apnoea (AHI >=5/h), in whom 40-45% develop hypertension, 60% develop nocturnal hypertension or non-dipping blood pressure, and 10-20% have resistant hypertension.

I

Intervention

Obstructive sleep apnoea (OSA) therapies including continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), weight loss strategies (e.g., tirzepatide), and emerging pharmacological therapies (acetazolamide, sulthiame, aroxybutynin, atomoxetine)

O

Outcome

Blood pressure control (including 24-hour ambulatory blood pressure, nocturnal dipping patterns, systolic and diastolic blood pressure) and risk of incident hypertensionsurrogate

Limitations

High heterogeneity exists in systolic and diastolic blood pressure responses to CPAP across populations.
The role of sex in the physiological response to OSA and hypertension risk has not yet been studied systematically.
Limited data exists on the association between hypoxic burden and hypertension.
Pathophysiological biomarkers of systemic inflammation, oxidative stress, and endothelial dysfunction have limited specificity due to involvement in other conditions.
The benefit of bedtime antihypertensive dosing has not yet been proven specifically in patients with OSA.
Large amount of heterogeneity exists in systolic and diastolic blood pressure data following CPAP across populations
Role of sex in the physiological response to OSA and hypertension risk has not yet been studied systematically
Limited data on the association of hypoxic burden with hypertension
Many biomarkers of systemic inflammation, oxidative stress, endothelial dysfunction, and vascular remodelling have limited specificity due to wide involvement in other conditions
Bedtime blood pressure medication dosing benefit shown in the OMAN trial has not yet been proven in patients with OSA

Implication

This congress review highlights the pathophysiological link between obstructive sleep apnoea and hypertension and emphasizes the need for personalized management integrating ambulatory blood pressure monitoring, biomarkers, CPAP, oral appliances, and weight loss.

Abstract

AT THE EUROPEAN Respiratory Society (ERS) Congress 2026 in Barcelona, Spain, specialists from across the globe came together to collaborate and showcase the latest breakthroughs in respiratory medicine.This informative session, chaired by Winfried Randerath, Solingen, Germany; Matteo Ciciliano, Rome, Italy; and Sophie E. Schiza, Heraklion, Greece, featured four insightful talks centred around the association between obstructive sleep apnoea and hypertension. A higher proportion of patients with OSA experience hypertension than in the general population Congress Feature • ERS 2026

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Cite This Study

Niamh Holmes (2026) conducted a review in Obstructive sleep apnoea and hypertension. Continuous positive airway pressure (CPAP) and alternative OSA therapies (mandibular advancement devices, weight management, pharmacotherapy) was evaluated on Blood pressure reduction and incident hypertension risk.

synapsesocial.com/papers/6ae28e75cbadf70daf6c42ed https://doi.org/10.33590/emjrespir/6cggvlyl

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From Cause to Treatment: Obstructive Sleep Apnoea as a Driver of Hypertension and a Target for Prevention

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

From Cause to Treatment: Obstructive Sleep Apnoea as a Driver of Hypertension and a Target for Prevention

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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