Eligible participants at baseline had more than 1 year of continuous insurance coverage, allowing gaps less than 90 days, and were free of CVD 1 year prior to OSA diagnosis.
A recent analysis of patients with obstructive sleep apnea (OSA) found that moderate to severe OSA with no continuous positive airway pressure (CPAP) use is associated with increased cardiovascular disease (CVD) incidence, whereas OSA with CPAP use was associated with decreased CVD incidence relative to no CPAP use, according to an American Academy of Sleep Medicine study.1
"Our study contributes to understanding the role of CPAP therapy for cardiovascular risk prevention," said lead author Diego R. Mazzotti, MD, 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."2
The research team analyzed adult patients with available-hypopnea index (AHI) between January 2018 and February 2020 in Kaiser Permanente Southern California. Eligible participants at baseline had more than 1 year of continuous insurance coverage, allowing gaps less than 90 days, and were free of CVD 1 year prior to OSA diagnosis. Each participant was separated between 3 groups: no OSA, OSA with any CPAP use, and OSA without evidence of CPAP use.1
For this study, CVD incidence was defined as first occurrence of myocardial infarction, stroke, unstable angina, heart failure, or CVD death, based on validated HER algorithms. The team used Cox proportional hazards models to assess the association between OSA with or without CPAP use and CVD incidence, adjusted for baseline age, sex, body mass index, race/ethnicity, Charlson comorbidity index, and use of anti-hypertensives and lipid-lowering medications.1
The study included 11,145 patients without OSA, 13,898 with OSA and CPAP use, and 20,884 patients without CPAP use. In adjusted models, moderate-severe OSA without CPAP use was associated with increased CVD incidence compared to no OSA. Further, OSA with any CPAP use was associated with lower CVD incidence compared to OSA patients with no CPAP use, whereas stronger effects were observed when restricting the sample to moderate-severe OSA, according to the study.1
"Our study, while observational, suggests that clinical trials focused on understanding how to sustain long-term CPAP adherence in obstructive sleep apnea patients are necessary and could be critical for optimizing comorbidity risk reduction," Mazzotti said in the press release.2