At least 4 hours of CPAP per day linked to reduced CV risk in secondary prevention
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Key takeaways:
- Good adherence to continuous positive airway pressure (CPAP) therapy vs. poor adherence was tied to lower CVD risk in secondary prevention.
- Good CPAP adherence was defined as 4 hours or more per day.
Good adherence to continuous positive airway pressure therapy may reduce risk for major adverse cardiac and cerebrovascular events in secondary prevention of CVD in patients with obstructive sleep apnea, researchers reported.
The researchers reported no significant difference in CVD risk when researchers compared patients assigned to continuous positive airway pressure (CPAP) with those not assigned to therapy for obstructive sleep apnea, according to findings published in JAMA.
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“The results of different randomized controlled trials have not shown a positive effect of CPAP treatment in reducing CV risk in patients with obstructive sleep apnea. A meta-analysis with individual patient data will allow us to analyze the effect of CPAP in different subgroups of patients,” Ferran Barbé, MD, FERS, ATSF, professor and chair of respiratory medicine at Hospital Universitari Arnau de Vilanova de Lleida, University of Lleida in Catalonia, Spain, told Healio.
To assess the impact of good adherence to CPAP on secondary CVD prevention, researchers conducted an individual participant data meta-analysis of three randomized trials evaluating outcomes with CPAP that included 4,186 participants (mean age, 61 years; 82% men; mean BMI, 29 kg/m2).
The main outcome was a composite of major adverse cardiac and cerebrovascular events and good CPAP adherence, which was defined as 4 hours or more per day.
The mean apnea-hypopnea index was 31.2 events per hour and 71% of participants had hypertension. Obstructive sleep apnea measures were similar among participants assigned to CPAP compared with those not assigned to CPAP.
Overall, 50.1% of the cohort received CPAP therapy, with an average adherence of 3.1 hours per day, and 38.5% had good adherence.
During a mean follow-up of 3.25 years, the risk for major adverse cardiac and cerebrovascular events was similar between patients who received CPAP compared with those who did not (HR = 1.01; 95% CI, 0.87-1.17; P = .94); however, the results of an on-treatment analysis showed that good adherence to CPAP, compared with poor adherence, was associated with lower risk (HR = 0.69; 95% CI, 0.52-0.92).
“CPAP, if used properly, inhibits the mechanisms related to atherogenesis and the risk of cardiovascular events — decreases sympathetic tone, regulates metabolism, reduces oxidative stress, hypercoagulability, etc,” Barbé told Healio. “I believe that these results will change the paradigm in the care of patients with a history of CV and sleep apnea. The doctor will insist on the message that CPAP used properly protects our patients.”
For more information:
Ferran Barbé, MD, FERS, ATSF, can be reached at febarbe.lleida.ics@gencat.cat.
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