Any CPAP use in obstructive sleep apnea reduces cardiovascular disease incidence

Patients with moderate to severe obstructive sleep apnea and no use of continuous positive airway pressure had higher rates of cardiovascular disease than patients who did use continuous positive airway pressure for any length of time.

Researchers first published findings from the large observational clinical sample in Sleep, the journal of the Sleep Research Society, and presented the study results at the society’s annual meeting, which is being held virtually. The researchers also found that obstructive sleep apnea with CPAP use correlated with lower rates of cardiovascular disease compared with no CPAP use.

“Our study contributes to understanding the role of CPAP therapy for cardiovascular risk prevention,” Diego R. Mazzotti, PhD, assistant professor in the division of medical informatics, department of internal medicine, at the University of Kansas Medical Center, said in a press release. “We found the effects of CPAP were stronger in patients with moderate to severe sleep apnea, as well as in patients who used CPAP, on average, greater than 4 hours per night.”

According to Mazzotti and colleagues, current research supports the benefit of CPAP therapy for cardiometabolic risk among adults with obstructive sleep apnea in the short term, but the “sustained effect” on cardiovascular disease risk is not clear. The researchers examined the relationship between CPAP use and cardiovascular disease rates among patients in the Kaiser Permanente Southern California health system.

The study included adult patients in the health system who had data on the apnea-hypopnea index available between January 2018 and February 2020. At baseline, eligible participants had a year or more of continuous insurance coverage that also allowed gaps for less than 90 days and were free of cardiovascular disease for 1 year before the diagnosis of obstructive sleep apnea.

The researchers assigned patients to one of three groups: no obstructive sleep apnea (apnea-hypopnea index, <5), obstructive sleep apnea (apnea-hypopnea index, 5) with any CPAP use (median, 2.5 hours per day) and obstructive sleep apnea with no evidence of CPAP use. They defined cardiovascular disease rates as the first incident of myocardial infarction, stroke, unstable angina, heart failure or cardiovascular death according to validated electronic health record algorithms. They calculated Cox proportional hazards models to examine the relationship between obstructive sleep apnea with or without CPAP use and cardiovascular disease incidence, adjusted for baseline age, sex, BMI, race/ethnicity, Charlson comorbidity index and use of antihypertensive and lipid-lowering medications. Mazzotti and colleagues also performed stratified analyses according to obstructive sleep apnea severity.

The analysis included 11,145 patients without obstructive sleep apnea, 13,898 with obstructive sleep apnea and CPAP use, and 20,884 patients with no CPAP use. The median follow-up period was 262 days (interquartile range, 129–409 days).

Mazzotti and colleagues reported cardiovascular disease incidence rates of 0.26% in patients without obstructive sleep apnea, 0.45% in patients with obstructive sleep apnea and CPAP use and 0.56% among patients with obstructive sleep apnea and no CPAP use. Adjusted models demonstrated that moderate-severe obstructive sleep apnea (apnea-hypopnea index, 15) with no CPAP use correlated with greater rates of cardiovascular disease compared with no obstructive sleep apnea (HR = 1.71; 95% CI, 1.11-2.64). Obstructive sleep apnea with any CPAP use was associated with reduced rates of cardiovascular disease (HR = 0.68; 95% CI, 0.5-0.93) compared with patients with obstructive sleep apnea and no CPAP use. The researchers noted stronger effects when they limited the sample to moderate-severe obstructive sleep apnea (HR = 0.56; 95% CI, 0.39-0.81).

“Our study, while observational, suggests that clinical trials focused on understanding how to sustain long-term CPAP adherence in [patients with obstructive sleep apnea] are necessary and could be critical for optimizing comorbidity risk reduction,” Mazzotti said in the press release.

Reference:

SLEEP 2021. Treating sleep apnea with CPAP therapy is associated with lower risk of heart problems. Available at: https://www.sleepmeeting.org/treating-sleep-apnea-cpap-therapy-associated-with-lower-risk-heart-problems/. Accessed June 11, 2021.