Does positive airway pressure (PAP) therapy reduce major adverse cardiovascular events in patients with obstructive sleep apnoea?
Recent large RCTs show neutral cardiovascular outcomes for PAP therapy in OSA, highlighting the need to consider trial design and adherence when interpreting these results.
Extract The association between obstructive sleep apnoea (OSA) and cardiovascular disease has long been recognised, but the role of positive airway pressure (PAP) therapy in modifying cardiovascular risk remains controversial 1–7. Over the past decade, large randomised controlled trials (RCTs) such as SAVE, ISAACC and RICCADSA have consistently reported neutral results with respect to major adverse cardiovascular events (MACEs) 8–10. These findings have led to scepticism about the capacity of PAP therapy to improve cardiovascular outcomes beyond symptomatic relief, particularly in non-sleepy patients or those with pre-existing cardiovascular disease. Yet, as with many questions in clinical medicine, trial design, adherence issues, and follow-up duration have clouded interpretation 11, 12.
Heinzer et al. (Sat,) studied this question.