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Continuous Positive Airway Pressure Treatment of Mild to Moderate Obstructive Sleep Apnea Reduces Cardiovascular Risk

¹ Department of Internal Medicine I, Marienhospital Herne, Ruhr University Bochum, Herne, Germany; ² Department of Internal Medicine, Bethesda Hospital, Wuppertal, Germany; and ³ Department of Cardiology and Angiology, St. Josef-Hospital/Bergmannsheil, Ruhr University Bochum, Bochum, Germany

Correspondence and requests for reprints should be addressed to Nikolaus J. Büchner, M.D., Department of Internal Medicine I, Marienhospital Herne, Ruhr University Bochum, Hoelkeskampring 40, D-44625 Herne, Germany. E-mail: nikolaus.buechner{at}rub.de

Rationale: Obstructive sleep apnea (OSA) is linked to increased cardiovascular risk, but the impact of mild forms of OSA and their treatment on cardiovascular outcomes remains controversial.

Objectives: To prospectively investigate cardiovascular outcomes in treated versus untreated patients with OSA.

Methods: Consecutive sleep laboratory patients with all degrees of OSA were included. Endpoints were nonfatal (myocardial infarction, stroke, and acute coronary syndrome requiring revascularization procedures) and fatal (death from myocardial infarction or stroke) cardiovascular events.

Measurements and Main Results: Comparison of event-free survival rates in treated versus untreated patients (Kaplan-Meier estimates, log-rank test). Of 449 patients enrolled (age, 56.0 ± 10.5 years; body mass index, 30.8 ± 5.4 kg/m²), 364 patients received OSA treatment, and 85 patients remained untreated. Median follow-up was 72.0 months (range, 1–156). Mean apnea–hypopnea index before treatment was 30.9 ± 21.8/hour in treated and 15.3 ± 13.0/hour in untreated patients, but there were no differences in cardiovascular comorbidities or risk factors. In patients with mild–moderate OSA (n = 288), events were more frequent in untreated patients (estimated event-free survival at 10 yr, 51.8 vs. 80.3% [P < 0.001]; absolute risk reduction, 28.5%; number needed to treat to prevent one event/10 yr, 3.5). After adjustment for age, gender, cardiovascular risk factors, and comorbidities at baseline, OSA treatment was an independent predictor for events (hazard ratio, 0.36; 95% confidence interval, 0.21–0.62; P < 0.001).

Conclusions: OSA treatment was associated with a cardiovascular risk reduction of 64% independent from age and preexisting cardiovascular comorbidities. OSA treatment should be considered for primary and secondary cardiovascular prevention, even in milder OSA.

Key Words: obstructive sleep apnea • continuous positive airway pressure therapy • outcome studies • cardiovascular mortality

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Recent studies demonstrated cardiovascular benefits in patients with severe obstructive sleep apnea (OSA) treated by continuous positive airway pressure. It is unclear whether patients with mild to moderate OSA also benefit as to cardiovascular outcome. What This Study Adds to the Field This study shows a benefit of continuous positive airway pressure treatment on cardiovascular outcome in patients with OSA. This effect was not restricted to patients with severe OSA.

 

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