Treat sleep apnea with positive airway pressure, but don’t expect it to prevent heart attacks
Clinical question: In patients with sleep apnea, does using positive airway pressure (PAP) treatment prevent adverse cardiovascular events and death?
Background: Previous observational studies have suggested that untreated sleep apnea is a factor in cardiopulmonary morbidity as well as cerebrovascular events. Guidelines advise its use for prevention of cerebrovascular events. However, not enough is known from trials about its impact on prevention of cardiovascular events.
Study design: Systematic review with meta-analysis.
Synopsis: The authors analyzed 10 randomized-controlled trials encompassing 7,266 patients with sleep apnea. They examined instances of major adverse cardiovascular events (MACE; acute coronary syndrome, stroke, cardiovascular death) as well as hospitalization for unstable angina and all-cause deaths, among others. They found no association between treatment with positive airway pressure and MACEs (169 events vs. 187 events, with a relative risk of 0.77; 95% confidence interval, 0.53-1.13) or all-cause death (324 events vs. 289 events, RR 1.13; 95% CI,0.99-1.29).
Bottom line: Positive airway pressure treatment for patients with sleep apnea is not an intervention to prevent cardiovascular morbidity.
Citation: Yu J et al. Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea. JAMA. 2017 Jul 11;318(2):156-66.
Dr. Sata is a medical instructor, Duke University Hospital.
