Abstract: Objective Assessing the efficacy of surgery for obstructive sleep apnea hypopnea syndrome(OSAHS)with or without refractory hypertension on blood pressure to provide a reference for the clinical treatment of OSAHS. Methods An electronic search was conducted in VIP, CNKI, and Pubmed databases. Studies were included according to inclusion and exclusion criteria. Literature quality was evaluated via the Methodological index for non-randomized studies(MINORS)system. Effects of surgery for obstructive sleep apnea hypopnea syndrome(OSAHS)on blood pressure were qualitatively evaluated and meta-analyzed with RevMan 5.3. Results Fifteen self-controlled trials or randomized controlled trials(RCTs)involving 989 patients were included. Selected blood pressure outcomes: ［24-hour average systolic blood pressure WMD=15.50, 95% confidence interval(CI, 11.14, 19.85), P<0.05; 24-hour average diastolic blood pressure WMD = 8.50, 95%CI(5.89, 11.11), P<0.05; average systolic blood pressure during the day WMD=13.74, 95%CI(9.10, 18.39), P<0.05; average diastolic blood pressure during the day WMD=8.42, 95%CI(6.06, 10.78), P<0.05; average systolic blood pressure during the night WMD=15.10, 95%CI(8.90, 21.30), P<0.05; average diastolic blood pressure during the night WMD=9.95, 95%CI(6.35, 13.54), P<0.05］. Selected outcomes in patients with OSAHS with refractory hypertension: ［24-hour average systolic blood pressure WMD=13.22, 95%CI(9.59, 16.84), P<0.05; 24-hour average diastolic blood pressure WMD=6.30, 95%CI(3.13, 9.46), P<0.05; average systolic blood pressure during the day WMD=13.32, 95%CI(8.25, 18.38), P<0.05; average diastolic blood pressure during the day WMD=5.62, 95%CI(3.60, 7.63), P<0.05; average systolic blood pressure during the night WMD=12.27, 95%CI(5.55, 18.98), P<0.05; average diastolic blood pressure during the night WMD=9.20, 95%CI(3.26, 15.13), P<0.05］; Selected outcomes on blood pressure after UPPP/H-UPPP: ［24-hour average systolic blood pressure WMD=13.61, 95%CI(4.21, 23.02), P<0.05; 24-hour average diastolic blood pressure, P>0.05; average systolic blood pressure during the day WMD=13.47, 95%CI(1.02, 25.91), P<0.05; average diastolic blood pressure during the day WMD=4.78, 95%CI(1.08, 8.48), P<0.05; average systolic blood pressure during the night WMD=16.81, 95%CI(3.68, 29.95), P<0.05; average diastolic blood pressure during the night WMD=13.66, 95%CI(3.07, 24.24), P<0.05; morning systolic blood pressure WMD=9.83, 95%CI(6.63, 13.02), P<0.05; morning diastolic blood pressure WMD=6.40, 95%CI(3.79, 9.00), P<0.05］; Two articles affirm that the experimental group(with UPPP+conventional treatment)has significantly better outcomes than the control group(conventional treatment only)on 24-hour SBP, 24-hour DBP, mSBP, and mDBP. Conclusion More high-quality studies are needed. It is challenging to distinguish the effect of each surgery on blood pressure because of small sample sizes in these studies. Surgery is effective in reducing the 24-hour average systolic blood pressure, 24-hour average diastolic blood pressure, average systolic blood pressure during the day, average diastolic blood pressure during the day, average systolic blood pressure during the night, and average diastolic blood pressure during the night in OSHAS patients with or without refractory hypertension. UPPP/H-UPPP additionally reduced morning systolic blood pressure and morning diastolic blood pressure but not 24-hour average diastolic blood pressure. The long-term efficacy remains to be studied.

Key words: Obstructive sleep apnea hypopnea syndrome, Surgery, Refractory hypertension, Meta analysis