CPAP reduces risk for cardiovascular death, hospitalizations in patients with OSA

Key takeaways:

• Risk for cardiovascular mortality was reduced with CPAP use vs. CPAP termination.
• Patients who used CPAP also had a decreased risk for cardiovascular-related hospitalization.

The risk for death and hospitalizations due to cardiovascular disease in patients with obstructive sleep apnea decreased with use of CPAP, according to a presentation at the European Respiratory Society International Congress.

“Our results suggest that CPAP treatment can help most OSA patients by preventing cardiovascular problems such as heart disease and stroke,” Jordi de Batlle, PhD, senior researcher at the Institut de Recerca Biomèdica de Lleida in Spain, said in a press release from the European Respiratory Society. “This is a plus, as CPAP treatment already helps most OSA patients by reducing sleepiness and improving their quality of life.”

In a population-based longitudinal observational study in Catalonia, de Batlle and colleagues evaluated 3,638 patients with OSA who stopped using CPAP in 2011 and 3,638 propensity score-matched patients with OSA who used CPAP until 2015 or death to evaluate the relationship between this treatment and the risk for major cardiovascular events. They also sought to assess whether baseline characteristics could affect this relationship.

“Randomized controlled trials have not shown a role for CPAP on the prevention of major cardiovascular events in OSA patients,” de Batlle said during his presentation. “However, we also know that those studies’ inclusion criteria and ethical constraints make the studied populations substantially different from real-world patients.”

Men made up the majority (71.5%) of the total cohort, and the median age was 66.5 years. Median follow-up was 4.5 years, with follow-up beginning in 2012 after a 1-year lag.

Overall, rates of all-cause death (11.5% vs. 7.48%; P < .001), cardiovascular death (3.79% vs. 2.61%; P = .005) and major cardiovascular events (10.3% vs. 8.63%; P = .018) appeared significantly higher in the CPAP termination group, with the rate of cardiovascular hospitalizations appearing comparable between the groups (8.63% vs. 7.37%).

Compared with patients who stopped using CPAP, researchers observed that the risk for death by cardiovascular disease was reduced by 36% (HR = 0.64; 95% CI, 0.49-0.83) among those who used CPAP in a model that accounted for age, sex and key comorbidities. Additionally, risk for death by any cause was reduced by 40% (HR = 0.6; 95% CI, 0.52-0.7) in these patients.

Moreover, those loyal to CPAP treatment had an 18% decreased risk for hospital admittance with cardiovascular disease, according to the press release.

However, researchers found no treatment effect based on male sex, age 70 years and older and baseline high blood pressure or ischemic heart disease.

“Based on these findings, we should encourage people with OSA to keep using their CPAP machines,” de Batlle said in the release.

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