A new systematic review and meta-analysis published in JAMA underscores the importance of continuous positive airway pressure (CPAP) adherence in the treatment of obstructive sleep apnea (OSA) in patients with cardiovascular disease (CVD).1 OSA is an independent risk factor for developing CVD.2 Observational studies have linked OSA severity and risk of cardiovascular (CV) events and shown that treatment of OSA with CPAP improves hypoxemia, daytime sleepiness, and concomitant hypertension,3 whereas interventional randomized controlled trials have not demonstrated the benefit of CPAP use in OSA for secondary CV prevention.4

The new study included data from three large randomized controlled trials that included 4,186 patients who were either given treatment for OSA with CPAP or usual care.1 According to the intention-to-treat analysis, the rates of major adverse cardiac or cerebrovascular events (MACCE) were not statistically significantly different among the CPAP-treated and non-CPAP groups. However, an individual participant data analysis of treatment time and other confounding factors revealed a decreased cardiovascular event risk associated with CPAP adherence. The use of CPAP, at > 4 hours per night, was associated with a reduced risk of MACCE with a significant hazard ratio of 0.69.

While adherence to treatment is complex and influenced by other factors, these study results may indicate a need to prioritize discussions around CPAP therapy adherence in patients with CVD and OSA.


1Sánchez-de-la-Torre M, Gracia-Lavedan E, Benitez ID, et al. Adherence to CPAP treatment and the risk of recurrent cardiovascular events: a meta-analysis. JAMA. 2023;330(13):1255-1265. doi:10.1001/jama.2023.17465.

2Sánchez-de-la-Torre M, Campos-Rodriguez F, Barbé F. Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med. 2013;1(1):61-72. doi:10.1016/S2213-2600(12)70051-6.

3Hu X, Fan J, Chen S, et al. The role of continuous positive airway pressure in blood pressure control for patients with obstructive sleep apnea and hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich). 2015;17(3):215-222. doi:10.1111/jch.12472.

4Labarca G, Dreyse J, Drake L, et al. Efficacy of continuous positive airway pressure (CPAP) in the prevention of cardiovascular events in patients with obstructive sleep apnea: systematic review and meta-analysis. Sleep Med Rev. 2020;52:101312. doi:10.1016/j.smrv.2020.101312.

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