CPAP effective in reducing cardiovascular mortality in a practice study

Patients suffering from obstructive sleep apnoea (OSA) can reduce their risk of dying from cardiovascular (CV) disease by using continuous positive airway pressure (CPAP). This was the main result of a large, observational, Spanish study that is contradictory to a couple of previously performed randomised-controlled clinical trials.

“With our study, we aimed to assess the impact of CPAP treatment on major CV events in a large, population-based study of real-world OSA patients from Catalonia,” explained Dr Jordi De Batlle Garcia (Institut de Recerca Biomèdica de Lleida, Spain) [1]. Previously, randomised-controlled trials have failed to show a role for CPAP in the prevention of major CV events in patients with OSA [2–4]. Dr De Batlle and his 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 to OSA patients continuing CPAP treatment. Propensity-matched analyses were applied to balance the treatment groups on confounding factors.

Overall, 3,638 OSA patients living in Catalonia who had chosen to stop using CPAP in 2011 could be identified. They were compared with a group of 3,638 OSA patients 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 of CV death than CPAP terminators, after adjusting for age, sex, and key comorbidities (HR 0.66; 95% CI 0.51–0.86). In addition, the risk for hospitalisation related to CV diseases (HR 0.82; 95% CI 0.70–0.96) and a composite endpoint of CV deaths and hospitalisations was lower (HR 0.80; 95% CI 0.69–0.93) in those who continued CPAP.

As Dr De Batlle emphasised, 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 commented on the study design. Still, in this analysis, CPAP continuation showed a significant protective effect on all-cause death, CV death, CV hospitalisations, and major CV events.

“Based on these findings, we should encourage people with OSA to keep using their CPAP machines,” Dr de Batlle concluded.

1. De Batlle J, et al. Impact of CPAP treatment on cardiovascular outcomes: a Catalan nationwide database analysis. Abstract 3290, ERS International Congress 2023, 9–13 September, Milan, Italy.
2. Sánchez-de-la-Torre M, et al. Lancet Respir Med 2020;8:359-67.
3. McEvoy RD, et al. N Engl J Med 2016;375:919-31.
4. Peker Y, et al. J Clin Med 2020;9:1-12.

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Posted on 29 October 202329 October 2023