Key result
Adherent CPAP reduces mean blood pressure by ~5 mm Hg in post-ACS obstructive sleep apnea.
Why the study?
Obstructive sleep apnea is prevalent in patients with acute coronary syndrome and is a cause of secondary hypertension, but its long-term effects and the impact of CPAP treatment on blood pressure are unclear.
Does good CPAP adherence reduce long-term blood pressure in patients with acute coronary syndrome and obstructive sleep apnea?
RCT (n=1,803)
randomly assigned
Does good CPAP adherence reduce long-term blood pressure in patients with acute coronary syndrome and obstructive sleep apnea?
Mean Difference: -4.7 (95% CI -6.7–-2.7)
Good CPAP adherence significantly reduces long-term blood pressure in patients with acute coronary syndrome and obstructive sleep apnea, particularly in those with severe OSA.
May support adherence emphasis for BP control in ACS+OSA; leaves open causal effects on outcomes.
Rationale Obstructive sleep apnea (OSA) is prevalent in patients with acute coronary syndrome (ACS) and is a cause of secondary hypertension. Objectives To explore the long-term effects of OSA and continuous positive airway pressure (CPAP) treatment on blood pressure (BP) in patients with ACS. Methods Post hoc analysis of the ISAACC study (Continuous Positive Airway Pressure in Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea; NCT01335087) included 1,803 patients admitted for ACS. Patients with OSA (apnea–hypopnea index [AHI], ⩾15 events/h) were randomly assigned to receive either CPAP or usual care and were seen in follow-up for 1–5 years. Office BP was determined at each visit. Results We included 596 patients without OSA, 978 patients in the usual care or poor CPAP adherence group, and 229 patients in the good CPAP adherence group. At baseline, 52% of the patients were diagnosed with hypertension. Median (25th to 75th percentile) age and body mass index were 59 (52.0 to 67.0) years and 28.2 (25.6 to 31.2) kg/m2, respectively. After a median (25th to 75th percentile) follow-up of 41.2 (18.3 to 59.6) months, BP changes were similar in the OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI, >40 events/h), with a maximum difference in mean BP of +3.3 mm Hg at 30 months. Patients with OSA with good CPAP adherence (⩾4 h/night) reduced mean BP after 18 months compared with patients with usual care/poor CPAP adherence, with a maximum mean difference (95% confidence interval) of −4.7 (−6.7 to −2.7) mm Hg. In patients with severe OSA, we observed a maximum mean difference of −7.1 (−10.3 to −3.8) mm Hg. Conclusions In patients with ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence. Clinical trial registered with www.clinicaltrials.gov (NCT 01335087).
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Sánchez‐de‐la‐Torre et al. (2022) conducted an RCT in Acute Coronary Syndrome and Obstructive Sleep Apnea (n=1,803). Continuous positive airway pressure (CPAP) vs. Usual care or poor CPAP adherence was evaluated on Mean blood pressure (MD -4.7 mm Hg, 95% CI -6.7 to -2.7). In patients with acute coronary syndrome and obstructive sleep apnea, good CPAP adherence reduced mean blood pressure compared to usual care or poor adherence (MD -4.7 mm Hg; 95% CI -6.7 to -2.7).
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