CPAP Lowers Cardiovascular Endpoints in a Real-World Scenario

Long-term CPAP use in patients with obstructive sleep apnea linked to lower cardiovascular death risk and improved outcomes in real-world study.

In a large longitudinal, observational study from Spain, patients with obstructive sleep apnea (OSA) who continued to use continuous positive airway pressure (CPAP) had a lower risk for cardiovascular (CV) death. Moreover, a couple of other CV endpoints improved.

Randomized controlled trials (RCTs) have failed to show a role for CPAP in the prevention of major CV events in patients with OSA. However, the situation in a real-world scenario might be different as extremely sleepy patients cannot be randomly assigned to a placebo group in an RCT due to ethical reasons. To assess the impact of CPAP on major CV events in real-world OS, Jordi De Batlle, PhD, and colleagues performed a population-based longitudinal observational study including all OSA patients terminating CPAP treatment in 2011 in Catalonia with no further CPAP prescriptions from 2012-2015 and compared them with patients with OSA continuing CPAP treatment. Propensity-matched analyses were applied to balance the treatment groups on confounding factors to make them comparable. Their results were presented at the 2023 ERS International Congress.

In total, 3,638 patients with OSA who had chosen to stop using CPAP in 2011 were identified. They were compared with a group of 3,638 patients with OSA who continued to use CPAP until at least 2015 or until death. During a median follow-up period of 4.5 years, CPAP continuators had a lower risk for CV death than terminators after adjusting for age, sex, and key comorbidities. In addition, the risk for hospitalization related to CV diseases and a composite endpoint of CV deaths and hospitalizations was lower in those who continued CPAP.

As Dr. De Batlle emphasized, the researchers did their best to ensure that CPAP termination did not occur due to a health issue, ultimately resulting in death or a major CV event. “However, and this is the main drawback of this analysis, we were missing key variables like OSA severity and CPAP treatment adherence” he said regarding the study design. Still, in this analysis, CPAP continuations showed a significant protective effect on all-cause death, CV death, CV hospitalizations, and major CV events.

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