What is the clinical evidence from this study?

Study design: Observational. Population: Adults aged ≥18 years with obstructive sleep apnea diagnosed by polysomnography or polygraphy and referred to a sleep laboratory in Israel between 2002 and 2019 (n=20854). Intervention: Continuous Positive Airway Pressure (CPAP) device dispensing vs. No CPAP device dispensing. Primary outcome: Changes in routinely collected cardiometabolic laboratory markers before and after CPAP dispensing index date.

What question did this study set out to answer?

This study aims to evaluate the relationship between CPAP therapy and cardiometabolic health markers in patients with obstructive sleep apnea.

March 7, 2026Open Access

CPAP and cardiometabolic markers in obstructive sleep apnea: a nationwide retrospective cohort

Key Result

CPAP device dispensing was associated with modest but statistically significant improvements in glucose (−8.2 mg/dL, p<0.01), HbA1c (−0.1%, p<0.01), LDL cholesterol (−6.7 mg/dL, p=0.01), total cholesterol (−4.0 mg/dL, p<0.01), triglycerides (−10.4 mg/dL, p<0.01), and reductions in antihypertensive medication dispensing (IRR 0.61, p<0.001) in adults with OSA.

Key Points

This study aims to evaluate the relationship between CPAP therapy and cardiometabolic health markers in patients with obstructive sleep apnea.
Analyzed data from a national health database of OSA patients from 2002 to 2019.
Compared patients based on CPAP dispensing status and timing.
Used descriptive statistics, t-tests, and chi-square tests for data analysis.
Among OSA patients, 37.4% had CPAP dispensing.
Patients with CPAP were older and had more comorbidities than those without it.
Significant reductions in glucose, HbA1c, total cholesterol, LDL cholesterol, and triglycerides observed in CPAP-dispensed patients.

Study Design

Type

Observational (n=20,854)

Multicenter

Yes

Structured PICO

Does CPAP device dispensing improve cardiometabolic laboratory markers and reduce medication use in adults with obstructive sleep apnea?

Population

10,977 adults (aged ≥18 years) with obstructive sleep apnea (OSA) diagnosed by polysomnography or polygraphy, mean age 60.6, 67.9% male, based in Israel. Key inclusion: sleep-laboratory referral. Key exclusion: pre-existing central or other non-obstructive sleep disorders, prior CPAP use, major upper-airway surgery, severe chronic respiratory disease, active malignancy, severe psychiatric disorders, neuromuscular diseases, pregnancy, or prescribed BiPAP.

Intervention

Continuous positive airway pressure (CPAP) device dispensing following sleep-laboratory evaluation in routine care.

Comparator

No CPAP device dispensing (patients referred to a sleep laboratory but not dispensed a CPAP device).

Outcome

Changes in routinely collected cardiometabolic laboratory markers (glucose, HbA1c, total, LDL and HDL cholesterol, triglycerides, C-reactive protein) compared before and after the index date.surrogate

CPAP dispensing in routine clinical practice is associated with modest improvements in cardiometabolic markers and a reduction in antihypertensive medication use among patients with obstructive sleep apnea.

Limitations

Retrospective observational design with potential residual confounding and misclassification.
Lack of objective OSA severity data such as apnea-hypopnea index (AHI).
No objective adherence data to CPAP device usage available.
Findings are associative and do not prove causality due to possible confounding by indication and surveillance bias.
Baseline differences between CPAP and non-CPAP groups may confound between-group comparisons.
Medication dispensing changes may reflect overall comorbidity management rather than direct CPAP effects.
Generalizability limited to Israeli health system and in-laboratory diagnosed OSA patients.
Lack of paired clinical blood pressure and symptom severity measures.
Absence of longitudinal data on BMI, smoking, and other lifestyle factors during follow-up.

Abstract

Obstructive sleep apnea (OSA) is a prevalent disorder and linked to significant comorbidities such as hypertension, cardiovascular disease, and metabolic syndrome, with continuous positive airway pressure (CPAP) therapy as the first-line treatment. This nationwide study examined demographic and comorbid characteristics of patients with OSA and evaluated the association between CPAP dispensing and changes in cardiometabolic markers and medication use in routine clinical practice. This retrospective cohort study used data from a national health database on patients diagnosed with OSA between 2002 and 2019. Patients were compared by CPAP dispensing status and by the CPAP dispensing index date, both before and after it, among CPAP-dispensed patients. Data analysis included descriptive statistics, t-tests, and chi-square tests. Among 20,854 patients with OSA, 10,977 (52.6%) underwent sleep laboratory testing, and 4,110 (37.4%) had CPAP dispensing. Patients with CPAP dispensing were older (61.9 ± 14.0 vs. 59.8 ± 15.3 years, p < 0.001) and had higher baseline rates of hypertension (80.6% vs. 75.2%, p < 0.001), cardiovascular disease (48.0% vs. 44.6%, p < 0.001) and atrial fibrillation (30.7% vs 27.2%, p < 0.001) than those without CPAP dispensing. In the CPAP-dispensed group, we observed modest but statistically significant improvements between the pre- and post-dispensing periods in glucose (− 8.2 mg/dL, p < 0.01), HbA1c (− 0.1%, p < 0.01), total cholesterol (− 4.0 mg/dL, p < 0.01), LDL cholesterol (− 6.7 mg/dL, p < 0.01), and triglycerides (− 10.4 mg/dL, p < 0.01), alongside an increase in HDL cholesterol. In this nationwide real-world cohort, CPAP dispensing was associated with statistically significant, albeit modest, improvements in metabolic markers and a reduction in antihypertensive medication use. Because OSA severity and adherence data were unavailable, these observational findings cannot be attributed solely to CPAP therapy and require confirmation in future studies. Not applicable – retrospective observational study, not a clinical trial.

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