Positive airway pressure therapy and cardiovascular events in obstructive sleep apnoea: an observational clinical...

Studies support the short-term benefit of continuous positive airway pressure (CPAP) therapy on cardiometabolic risk in adults with obstructive sleep apnoea (OSA). Evidence is limited on the benefits of CPAP for preventing acute major adverse cardiovascular events (MACE). This study aimed to assess the association between CPAP use and incidence of MACE in a longitudinal clinical cohort of adults with OSA at a large U.S. healthcare system.

Adults with OSA (apnoea-hypopnoea index [AHI]≥5) were identified from Kaiser Permanente Southern California between 2018 and 2020 (N = 34,782). MACE was defined as first occurrence of myocardial infarction, stroke, unstable angina, heart failure or cardiovascular death, using validated electronic health record algorithms. CPAP use (h/night) was based on daily telemonitoring data. Inverse probability of treatment weighted Cox proportional hazards models stratified by OSA severity (mild [5≤AHI<15]), moderate-severe [AHI ≥15]), were used to assess associations between CPAP use and MACE.

Among individuals with moderate-severe OSA, those using CPAP <4 h/night (HR [95 % CI] = 0.53 [0.35-0.82]; p = 0.004) or ≥4 h/night (HR [95 % CI] = 0.46 [0.27-0.77]; p = 0.004) had lower MACE incidence compared to those not using CPAP. Increased CPAP use (in hours) was associated with lower MACE incidence in moderate-severe OSA (HR [95 % CI] = 0.90 [0.82-0.98]; p = 0.021). In individuals with mild OSA, CPAP use was not associated with lower MACE incidence.

CPAP use was associated with lower MACE incidence in adults with moderate-severe OSA. Treatment of moderate-severe OSA may have a positive impact on prevention of MACE.