Good use of CPAP therapy for the treatment of sleep apnoea reduces the risk of serious cardiovascular events by up to 31%

Good use of continuous positive airway pressure (CPAP) therapy for the treatment of sleep apnoea reduces the risk of reoccurrence of cardiovascular and cerebrovascular events by up to 31%, according to research led from Lleida that has been published in the prestigious international journal Journal of the American Medical Association (JAMA). This finding shows that CPAP therapy may be a key factor in cardiovascular prevention in patients with obstructive sleep apnoea and established cardiovascular disease.

"The results of this study have enormous clinical relevance in the management of cardiovascular risk in patients with sleep apnoea. Thus, this study highlights the importance and necessity of daily compliance with CPAP treatment by the CPAP-treated patient during the entire sleep period. These findings will change the clinical guidelines for the management of sleep apnoea," explained Ferran Barbé Illa and Manuel Sánchez de la Torre, lead authors and authors of the published study.

A highly prevalent but under-diagnosed condition

Obstructive sleep apnoea affects 20-30% of the adult population, and 80% of those affected are undiagnosed. It is a common, chronic disorder characterised by occlusion of the upper airway during sleep, resulting in intermittent oxygen deprivation, sleep fragmentation and changes in intrathoracic pressure.
Patients with sleep apnoea are at increased risk of cardiovascular disease. Previous research, such as the SAVE, ISAACC and RICCADA studies, found that the application of continuous positive airway pressure in patients with established cardiovascular disease and obstructive sleep apnoea has a neutral effect on the secondary prevention of new recurrent cardiovascular events, i.e. it has no positive effect on preventing major cardiovascular events.

Patients with sleep apnoea have an elevated risk of cardiovascular disease. Previous research, such as the SAVE, ISAACC and RICCADA studies, found that continuous positive airway pressure in patients with established cardiovascular disease and obstructive sleep apnoea has a neutral effect on the secondary prevention of new recurrent cardiovascular events, i.e. it has no positive effect on preventing major cardiovascular events.

This new research demonstrates that adequate adherence to CPAP therapy (greater than four hours of use per night) is a key factor in secondary cardiovascular prevention and in reducing the risk of recurrence of a major cardiovascular event. "Until now there was no such evidence and it could only be recommended on the basis of symptom improvement, which meant that some patients did not have adequate adherence. This new research has shown that its effect is not neutral and, above all, that it is not cumulative," explains Ferran Barbé, who makes an analogy with sun protection. "The fact that I used sunscreen yesterday does not protect me from exposure today. Similarly, we have seen that the protection of CPAP therapy is only when it is used for at least four hours a day, and that it disappears when the patient stops using it or uses it for less time".
The research has been conducted by analysing t

The research has been conducted by analysing three studies (known as a meta-analysis) with data from 4,186 patients. "Individually, in the three previous clinical trials, a beneficial effect of CPAP treatment could not be demonstrated. Now, thanks to the analysis of the combined data from these three large clinical trials, we have been able to demonstrate that those patients who make correct use of sleep apnoea treatment with the CPAP device manage to reduce the risk of suffering a new serious cardiovascular event," added the researchers, who explain that this new analysis has been possible thanks to the large database available from the three studies, which would not have been possible to carry out individually.

Ferran Barbé is regional clinical director of Chronic Respiratory Diseases at the Hospital Universitari Arnau de Vilanova (HUAV), professor at the University of Lleida (UdL) and leader of the Translational Research in Respiratory Medicine group at the Institute for Research in Biomedicine of Lleida (IRBLleida) and the Centre for Biomedical Research in Respiratory Diseases Network (CIBERES). Manuel Sánchez is a Ramon y Cajal researcher, lecturer in the Department of Nursing and Physiotherapy at the UdL and leader of the Precision Medicine in Chronic Diseases group at IRBLleida.

The research has involved the participation of researchers from the Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), Flinders University and the University of New South Wales in Australia, the University of Concepción and the Clínica Las Condes in Chile, Harvard Medical School and the University of Pittsburgh in the United States, the University Medical Center Hamburg-Eppendorf in Germany, the University of Goteburg, Skarabrg Hospital, Lund University in Sweden, and Istanbul University College in Turkey.

The research has been funded through projects granted by the Instituto de Salud Carlos III (ISCII) (PI10/02763, PI10/02745, PI18/00449, PI19/00907, PI21/00337), the European Union, through the ERDF A way to do Europe, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Centre of Pneumology and Thoracic Surgery (SEPAR), the Spanish Centre of Pneumology and Thoracic Surgery (SEPAR) and the Spanish Centre of Pneumology and Thoracic Surgery (SEPAR).

Image: The researchers: Ivan Benítez, Ferran Barbé Illa, Manuel Sánchez de la Torre and Anna Moncusí

Article: Sánchez-de-la-Torre M, Gracia-Lavedan E, Benitez ID, Sánchez-de-la-Torre A, Moncusí-Moix A, Torres G, Loffler K, Woodman R, Adams R, Labarca G, Dreyse J, Eulenburg C, Thunström E, Glantz H, Peker Y, Anderson C, McEvoy D, Barbé F. Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis. JAMA. 2023 Oct 3;330(13):1255-1265. doi: 10.1001/jama.2023.17465. PMID: 37787793.