Does treatment of nonsleepy OSA with CPAP therapy change CVD risk? A systematic review

Objective(s): This review assesses Continuous Positive Airway Pressure (CPAP) therapy’s effectiveness in reducing cardiovascular disease (CVD) risk in obstructive sleep apnea (OSA) patients, particularly its impact on hypertension and nonfatal cardiovascular events in non-sleepy individuals. Data Sources: This systematic searched across Embase, PubMed, and Medline, from inception up to April 10th, 2025. Methods: We identified relevant studies focusing on CPAP’s cardiovascular effect on non-sleepy OSA patients. The analysis included randomized controlled trials (RCTs), observational studies, and excluded non-English articles or those not addressing direct CV-outcomes. Results: Out of 12 studies, findings were mixed: Blood Pressure (BP): CPAP may lower BP in some moderate-to-severe OSA patients, though results varied. Cardiac Function: Evidence suggests improvements in cardiac function and structure, including left ventricular ejection fraction and mass index, in some patients. Cardiovascular Incidence and Mortality: The effect of CPAP on reducing CV-events and mortality was inconsistent, with some studies noting benefits in adherent patients, while others found no significant impact. Conclusion: CPAP therapy shows potential benefits for cardiovascular health in non-sleepy OSA patients, including BP-reduction and cardiac function improvement. However, the impact on more severe CV-outcomes requires further investigation. CPAP remains an important treatment for OSA, emphasizing the need for adherence and early intervention for optimal outcomes.