CPAP treatment did not significantly reduce major cardiovascular events compared to usual care in large RCTs, but observational studies suggest adherence to CPAP (≥4 h/night) is associated with reduced all-cause mortality (HR 0.53), lower MACE (HR 0.90), and lower cardiovascular events (HR 0.29 in adherent subgroup).
Does continuous positive airway pressure (CPAP) therapy improve cardiovascular outcomes in patients with coronary artery disease and obstructive sleep apnea?
Obstructive sleep apnea is a significant risk factor for adverse outcomes in coronary artery disease, but the cardiovascular benefits of CPAP therapy remain dependent on patient adherence.
Obstructive sleep apnea syndrome (OSA) is increasingly recognized as a common and clinically relevant comorbidity in coronary artery disease (CAD). Epidemiological studies demonstrate that OSA is highly prevalent among patients with CAD and independently increases the risk of myocardial infarction, accelerated atherosclerosis, and recurrent adverse events. The pathophysiological mechanisms underlying this association include intermittent hypoxia, sympathetic overactivation, oxidative stress, endothelial dysfunction, systemic inflammation, metabolic dysregulation, and pro-prothrombotic changes. These processes converge to promote coronary plaque formation, instability, and ischemia. Clinical evidence indicates that OSA contributes to silent nocturnal ischemia, higher rates of acute coronary syndromes, restenosis after percutaneous coronary intervention, and worse prognosis following myocardial infarction or surgical revascularization. Continuous positive airway pressure (CPAP) therapy improves blood pressure, endothelial function, and surrogate markers of ischemia, but large randomized trials have yielded neutral results on major cardiovascular events, largely due to suboptimal adherence. However, observational studies, however, suggest improved survival in patients who are adherent to CPAP therapy. Lifestyle interventions, particularly weight reduction, remain essential adjunctive strategies. This review synthesizes current evidence, evaluates therapeutic implications, and highlights the need for systematic OSA screening in CAD populations. Future research should focus on patient phenotyping, treatment adherence, and integrated care models to improve cardiovascular outcomes.
Tetaj et al. (2026) conducted a review in Adults with coronary artery disease (CAD) and obstructive sleep apnea (OSA), including those with acute coronary syndrome, post-revascularization, and moderate to severe OSA. Continuous positive airway pressure (CPAP) therapy vs. Usual care or no CPAP was evaluated on Major adverse cardiovascular events (MACE) including cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, coronary revascularization. CPAP treatment did not significantly reduce major cardiovascular events compared to usual care in large RCTs, but observational studies suggest adherence to CPAP (≥4 h/night) is associated with reduced all-cause mortality (HR 0.53), lower MACE (HR 0.90), and lower cardiovascular events (HR 0.29 in adherent subgroup).