Long-term Effects of Nasal Continuous Positive Airway Pressure Therapy on Cardiovascular Outcomes in Sleep Apnea Syndrome

doi:10.1378/chest.127.6.2076

Chest

Volume 127, Issue 6, June 2005, Pages 2076-2084

https://doi.org/10.1378/chest.127.6.2076 Get rights and content

Background

Obstructive sleep apnea syndrome (OSAS) has been associated with increased morbidity and mortality, principally from cardiovascular disease, but the impact of nasal continuous positive airway pressure (CPAP) therapy is unclear.

Methods

We performed a long-term follow-up study of 168 patients with OSAS who had begun receiving CPAP therapy at least 5 years previously, most of whom had been prospectively followed up, having been the subject of an earlier report on cardiovascular risk factors in OSAS patients. The average follow-up period was 7.5 years. We compared the cardiovascular outcomes of those patients who were intolerant of CPAP (untreated group, 61 patients) with those continuing CPAP therapy (107 patients).

Results

CPAP-treated patients had a higher median apnea-hypopnea index score than the untreated group (48.3 [interquartile range (IQR), 33.6 to 66.4] vs 36.7 [IQR, 27.4 to 55], respectively; p = 0.02), but age, body mass index, and time since diagnosis were similar. Deaths from cardiovascular disease were more common in the untreated group than in the CPAP-treated group during follow-up (14.8% vs 1.9%, respectively; p = 0.009 [log rank test]), but no significant differences were found in the development of new cases of hypertension, cardiac disorder, or stroke. Total cardiovascular events (ie, death and new cardiovascular disease combined) were more common in the untreated group than in the CPAP-treated group (31% vs 18%, respectively; p < 0.05).

Conclusions

The data support a protective effect of CPAP therapy against death from cardiovascular disease in patients with OSAS.

Section snippets

Patient Selection

Approval for the study was obtained from our hospital ethics committee. Patients included the cohort of patients whose baseline data have previously been reported,²⁰ in addition to those patients who had OSAS diagnosed between 1990 and 1995 in our sleep laboratory, where similar baseline data were available. All patients fulfilled the entry criteria of an apnea-hypopnea index (AHI) of >15 events per hour on overnight sleep studies performed with a polysomnography system (Oxford Medilog SAC847

Results

Patients in whom OSAS was diagnosed were offered CPAP therapy within at least 3 months of receiving the diagnosis. A total of 223 patients satisfied the inclusion criteria. Despite repeated attempts by mail, telephone, and contacting of the family physician, which were indicated in the patient's clinical records, we were unable to collect follow-up information from 55 patients, which resulted in an overall 75% response rate. A chart review of the patients in whom follow-up information could not

Discussion

This study supports a beneficial effect of long-term CPAP therapy on cardiovascular mortality in patients with OSAS, which was independent of age, BMI, smoking and alcohol history, and severity of OSAS. The only significant difference between the CPAP group and the untreated group at baseline was a higher AHI in the CPAP group, which might have been expected to predispose those patients to a higher incidence of cardiovascular disease than those in the untreated group, as has been observed.⁸

Acknowledgment

The authors gratefully acknowledge the statistical advice of Dr. Hugh Mulcahy in data analysis.

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Chest

Clinical InvestigationsLong-term Effects of Nasal Continuous Positive Airway Pressure Therapy on Cardiovascular Outcomes in Sleep Apnea Syndrome

Background

Methods

Results

Conclusions

Section snippets

Patient Selection

Results

Discussion

Acknowledgment

Lancet

Chest

Chest

Chest

Sleep Med Rev

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

Sleep-disordered breathing and self-reported general health status in the Wisconsin Sleep Cohort Study

Sleep

Drivers with untreated sleep apnea: a cause of death and serious injury

Arch Intern Med

Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study

Am J Respir Crit Care Med

Sleep apnea and cardiovascular disease

Am J Respir Crit Care Med

Sleep apnea in acute cerebrovascular diseases: final report on 128 patients

Sleep

Respiratory disturbance index: an independent predictor of mortality in coronary artery disease

Am J Respir Crit Care Med

Sleep apnea in 81 ambulatory male patients with stable heart failure

Circulation

Prospective study of the association between sleep-disordered breathing and hypertension

N Engl J Med

Population-based study of sleep-disordered breathing as a risk factor for hypertension

Arch Intern Med

Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study

JAMA

Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence

BMJ

Mortality in sleep apnea patients: a multivariate analysis of risk factors

Sleep

Mortality of sleep apnoea patients treated by nasal continuous positive airway pressure registered in the ANTADIR observatory: Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique

Eur Respir J

Clinical Investigations
Long-term Effects of Nasal Continuous Positive Airway Pressure Therapy on Cardiovascular Outcomes in Sleep Apnea Syndrome