Background

The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated.

Aim

To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of cardiovascular events in randomized controlled trials (RCTs).

Methods

Individual participant data (IPD) meta-analysis was performed according to PRISMA guidelines. We included RCTs addressing the effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA. IPD were requested from the three selected. Main outcome was risk of recurrent major adverse cardiovascular and cerebrovascular events (MACCEs). One- and two-stage IPD meta-analysis and an on-treatment analysis were performed.

Results

A total of 4186 patients were evaluated (82% men, body mass index (mean [SD]) 28.9[4.5] kg/m2, age 61.2[8.7] years, apnea-hypopnea index 31[17] events/h, 71% hypertensive, 50.1% on CPAP (mean compliance 3.1[2.4] hours/day), 49.9% no-CPAP, follow-up 3.3[1.8] years). The first MACCE was similar for CPAP and no-CPAP groups (HR 1.01; [95%CI: 0.87-1.17]). However, an on-treatment analysis revealed a reduced risk of MACCE in adherent to CPAP patients (HR 0.66 [0.52-0.85]).

Conclusions

The adherent use of CPAP treatment is associated with a reduced MACCE recurrence risk, suggesting that treatment compliance is a key factor in secondary cardiovascular prevention in patients with OSA.

Funding: ISCII (PI10/02763-PI10/02745-PI18/00449-PI19/00907-PI21/00337) cofunded by European Union, SEPAR, ResMed Ltd. ALLER, CIBERES. MS received support from "Ramón y Cajal" grant (RYC2019-027831-I).