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Does PAP therapy truly reduce mortality in OSA?

Presented by
Dr Atul Malhotr, University of California San Diego, CA, USA
ATS 2024
A systematic review and meta-analysis supports the use of positive airway pressure (PAP) therapy to reduce all-cause mortality in patients with obstructive sleep apnoea (OSA). According to the authors, future research should explore causal pathways and effect modifiers for the observed benefit of PAP therapy.

“PAP therapy is the treatment of choice in patients with OSA, delivering marked improvements in patient-reported quality-of-life outcomes,” said Dr Atul Malhotr (University of California San Diego, CA, USA). “However, the impact of PAP therapy on all-cause mortality in this population is not clear.” The current systematic literature review and meta-analysis evaluated the association between all-cause mortality and PAP therapy in patients with OSA [1]. The authors included 10 randomised trials and 17 non-randomised studies with all-cause mortality as outcome measure, resulting in a total sample size of 1,164,880 patients. In addition, they included 6 randomised controlled trials and 5 non-randomised-controlled studies with cardiovascular mortality as an outcome measure.

Overall, PAP therapy had a significant impact on all-cause mortality in patients with OSA (HR 0.63; 95% CI 0.56–0.72; P<0.001). Dr Malhotra mentioned that there was a trend towards a better treatment effect if the treatment adherence was higher: the treatment effect was 16% greater in patients using PAP therapy for at least 4 hours per night compared with patients who used PAP therapy for fewer than 4 hours per night. Next, PAP therapy reduced cardiovascular mortality in patients with OSA (HR 0.46; 95% CI 0.29–0.73; P=0.001).

The current study thus indicates that PAP therapy is an effective treatment to reduce all-cause mortality in patients with OSA across diverse populations.

  1. Malhotra A, et al. All-cause mortality in OSA: systematic literature review including randomized trials and confounding adjusted non-randomized controlled studies and meta-analysis of PAP treatment. Sleep apnea unplugged: navigating a myriad of health outcomes. ATS 2024, 17–22 May, San Diego, USA.

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