A recent study found that about 50% of a random sample of adults in the USA had moderate to severe sleep apnea on sleep testing that was previously undiagnosed. This huge number is due in part to the rise in obesity. Some patients resist sleep studies and even more diagnosed with obstructive sleep apnea (OSA) struggle with tolerating continuous positive airway pressure (CPAP) therapy when prescribed.
It would seem obvious if more benefits could be attributed to CPAP therapy in patients with OSA then patients might be more motivated to regularly wear their CPAP. Two new studies recently presented demonstrated remarkable advantages for CPAP in OSA.
STUDY 1: Continued Use of CPAP Reduces the Risk of Cardiac Events Including Death
Data from the Pays de la Loire Sleep Cohort were linked to the French national health insurance database to identify incidents of major adverse cardiac events (MACEs) like death, stroke, and cardiac disease.
After a median follow-up of 8 years, 1130 (24%) of 4,775 patients experienced MACEs. In addition, 1679 (35%) had discontinued PAP treatment while 3,096 remained PAP adherent.
After adjustment for major confounders including CV drug status, CPAP discontinuation was associated with a 30% increased risk of MACEs compared to adherent PAP continuation.
Over the study period, patients who stuck with CPAP treatment reduced their risk of death from heart disease by 36%. And they had a 40% lower risk of death from any cause, the study found.
The authors concluded that in real-life conditions, CPAP treatment discontinuation was associated with an increased risk of MACEs after adjustment for confounders. Those who continued CPAP had a lower risk of death and other outcomes.
STUDY 2: CPAP Reduces Coronary Plaque on CT Imaging
30 patients with moderate to severe OSA were randomized to CPAP, liraglutide injections for weight loss (sold as Victoza and Saxenda) alone, or both in combination for 24 weeks. All patients underwent CT Coronary Angiogram (CCTA) at baseline and those with visible coronary artery disease on the initial scan underwent repeat scans at study completion. Coronary artery quantitative plaque volume analysis was performed using automated AI-enabled cardiac CT software.
Low-density coronary artery plaque volume decreased with CPAP (from 571±490 to 334±185mm3) and with combination therapy (from 401±145 to 278±126mm3) but not with the weight loss medication alone.
The authors concluded that the data suggest that CPAP therapy, but not medication-mediated weight loss, may reduce low-attenuation coronary artery plaque volume in patients with OSA.
COMMENTS
Professor Sophia Schiza, who is secretary of the European Respiratory Society’s group assembly on sleep-disordered breathing and was not involved in the research, said:
“We know that people with obstructive sleep apnoea are at a higher risk of cardiovascular problems, but there are conflicting data on the effects of CPAP on reducing this risk. However, research using real-world data is showing that CPAP adherence is one of the key predictors for reducing cardiovascular risk and for better outcomes in general. Here we have two studies: one large study showing that CPAP could help lower the risk of developing or dying from cardiovascular disease in people suffering from OSA and another small study suggesting that CPAP could be more beneficial than weight-loss therapy for people suffering from OSA.
“OSA is an extremely common disease, with consequences for people’s daytime functioning and the health of their hearts, blood vessels, and metabolism. One of the treatment options is CPAP, and the more the patients use CPAP every night, the greater the reduction in cardiovascular illness and death. Therefore, there is a need for individualised treatment plans, patient engagement, educational activities, and close treatment follow-up in order to increase adherence to long-term treatment and improve outcomes for patients.”
