People with obstructive sleep apnea (OSA) have an increased risk of cardiovascular problems, but there is conflicting data regarding the effects of CPAP on reducing this risk. A study now shows that CPAP could help to reduce the risk of cardiovascular disease or death in people with OSA.
OSA sufferers often snore loudly, their breathing stops during the night and they may wake up several times. This can reduce the amount of oxygen in the blood and lead to tiredness. It can also increase the risk of high blood pressure, stroke, heart disease and type 2 diabetes. CPAP (Continuous Positive Airway Pressure ) devices are offered to people with OSA to help them sleep better. They blow air through a face mask during the night to prevent the user’s airways from closing. Research on the effects of CPAP on cardiovascular disease has produced mixed results to date, but real-world data suggests that CPAP adherence is one of the most important predictors of cardiovascular risk reduction and better outcomes in general. A Spanish study has now shown that OSA patients can reduce their risk of dying from cardiovascular disease if they wear a CPAP mask at night [1].
The study was presented by Dr. Jordi de Batlle from the Institut de Recerca Biomèdica de Lleida in Lleida, Spain. Over a median follow-up period of 4.5 years, he and his colleagues followed all 3638 OSA patients living in Catalonia who had decided to stop their CPAP therapy in 2011. They compared their data with a similar group of 3638 OSA patients who continued to use CPAP until at least 2015 or until death (median age 66.5 years, 71.5% male).
When comparing the two groups, after adjusting for age, gender and major comorbidities, the researchers found that those who continued to use CPAP masks had a 40% lower risk of dying from any cause, a 36% lower risk of dying from cardiovascular disease and an 18% lower risk of being hospitalized with cardiovascular disease.
Their population-based longitudinal observational study showed a moderate but significant protective effect of CPAP on serious cardiovascular events. This correlation is in contrast to the results of randomized controlled trials on this topic and underlines the need to include patients from the real world in the studies. “Our results suggest that CPAP treatment can help most OSA patients by preventing cardiovascular problems such as heart disease and strokes,” explained Dr. de Batlle. This is another plus point, as CPAP therapy is already helping most OSA patients by reducing their sleepiness and improving their quality of life. “Based on these results, we should encourage people with OSA to continue using their CPAP devices.”
CPAP reduced plaque formation
According to the results of a pilot study, which was also presented at the ERS congress, CPAP can also reduce the formation of plaque in the arteries around the heart better than a weight loss medication [2]. Dr. Cliona O’Donnell, a consultant in respiratory medicine at St. Vincent’s University Hospital and University College Dublin, Ireland, and colleagues conducted their study of 30 OSA patients who underwent computed tomography (CT) scans to detect signs of narrowing in the blood vessels that supply the heart.
Patients were then randomly assigned to a 24-week treatment in which they received either a CPAP machine at night or injections of liraglutide for weight loss, or both together. Patients who showed signs of coronary heart disease at the first examination were re-examined at the end of the 24-week treatment period. The researchers used a program with artificial intelligence (AI) to analyze the patients’ scans.
Participants treated with CPAP and those receiving CPAP and weight loss injections experienced a reduction in plaque formation in the arteries and a decrease in inflammation in the aorta (under CPAP, plaque volume decreased from 571±490 to 334±185 mm3under combination therapy from 401±145 to 278±126 mm3). These effects did not occur in patients who were only treated with injections for weight reduction (Fig. 1).
“The continuous positive airway pressure keeps the patient’s airways open during sleep. This prevents fluctuations in blood oxygen levels, which can exacerbate cardiovascular disease,” Dr. O’Donnell explained the effect. Although this is a pilot study, no clear conclusions can be drawn. “But we have found that some early signs of cardiovascular disease have improved with CPAP treatment.” This should now be investigated further in larger studies, the doctor concluded.
Sources:
- de Batlle J: Presentation “Impact of CPAP treatment on cardiovascular outcomes: a Catalan nationwide database analysis”; Session “Positive airway pressure for sleep-disordered breathing: adherence and outcomes”; ERS Congress 2023, 11.09.2023.
- O’Donnell C: Presentation “The effect of CPAP therapy on coronary artery plaque volume in obstructive sleep apnea: data from a proof-of-concept study”; Session “Positive airway pressure for sleep-disordered breathing: adherence and outcomes”; ERS Congress 2023, 11.09.2023.
InFo PNEUMOLOGIE & ALLERGOLOGIE 2023; 5(4): 34-35 (published on 9.11.23, ahead of print)
