Obstructive sleep apnea (OSA), where blockages in the airways cause breathing to uncontrollably stop and start during sleep, is a common sleep-related breathing disorder. Continuous positive airway pressure (CPAP) machines can reduce interrupted sleep for patients with OSA. While CPAP improves symptoms, it has been unclear whether CPAP also reduces the risk of heart disease. A new study by investigators from Mass General Brigham aimed to understand if using a CPAP machine could also protect the heart and brain from cardiovascular events in people with OSA. Their findings, published in European Heart Journal, suggest that a more personalized approach for treating patients is needed—one that focuses on CPAP treatment for those who stand to gain the most, while exercising caution for those who may not benefit and could even be harmed.
The research team analyzed data from 3,549 participants with a median age of 61 years from three previous trials of patients with OSA and cardiovascular disease; half were using CPAP and half were not. They tracked the patients for three years on average, looking for the occurrence of cardiovascular mortality, stroke, and heart attack. Although there were no overall differences in the development of these outcomes between those who were using CPAP and those not using CPAP, CPAP users who were classified as having high risk markers (i.e., large drops in their oxygen levels or increases in their heart rates associated with their OSA) had a 17% lower risk. Furthermore, when analyses were restricted to those without excessive sleepiness or elevated blood pressures, this finding was magnified with risk reductions of 24% and 28% respectively. For those without high risk markers, there was an increase in the occurrence of these outcomes.
“Through our study, we found a subgroup of patients who experience cardiovascular benefits from CPAP use,” said first author Ali Azarbarzin, PhD, of the Division of Sleep and Circadian Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “This is the first step in making better therapeutic recommendations for patients with obstructive sleep apnea in the future to reduce their risk of heart attack, stroke, and death. Changing clinical practice is going to require a further prospective study to validate our findings," said Azarbarzin. "In the meantime, patients with OSA should speak with their doctors to weigh the potential risks and benefits of different treatment options. These conversations can begin the process of personalizing obstructive sleep apnea care and reducing cardiovascular events in this vulnerable population.”