Research Summary

Patient Adherence to CPAP Treatment For Obstructive Sleep Apnea and Risk of Cardiovascular Events

Jessica Ganga

Individuals who use continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) may reduce their risk of recurrent major cardiovascular events, according to a systematic review of clinical trial data.

Although CPAP treatment has been shown to reverse the symptoms associated with OSA in previous studies, its efficacy regarding the prevention of cardiovascular events in OSA is less understood. A team of researchers sought to assess the effect of CPAP treatment for OSA on the risk of adverse cardiovascular events.

In total, 4186 individuals were evaluated across multiple databases including PubMed, EMBASE, and others. Of the total, 71% of individuals had hypertension, 50.1% received CPAP treatment, and 49.9% did not receive CPAP treatment.

One-stage and two-stage individual participant data meta-analyses were completed. Researchers estimated the effect of CPAP treatment risk on recurrent major adverse cardiac and cerebrovascular (MACCEs).

The main outcome of the study was defined as the first MACCE, and this outcome was similar for both the CPAP and no CPAP groups (hazard ratio = 1.01 [95% CI, 0.87-1.17]). On further analysis, researchers used a marginal structural model and found a lower risk of MACCEs associated with what the authors considered good adherence to CPAP (hazard ratio = 0.69 [95% CI, 0.52-0.92]).

This study had limitations. For example, while the meta-analysis evaluated CPAP as the criterion-standard treatment for OSA, alternative treatments that have shown efficacy such as mandibular advancement devices, hypoglossal nerve stimulation, or positional therapy should be examined as well.

"Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA,” the authors concluded.


Sánchez-de-la-Torre M, Gracia-Lavedan E, Benitez ID, et al. Adherence to CPAP treatment and the risk of recurrent cardiovascular events. JAMA. 2023;330(13):1255-1265. doi:10.1001/jama.2023.17465