Stronger differential effect for CPAP seen for those without excessive sleepiness, without increased blood pressure
By Elana Gotkine HealthDay Reporter
WEDNESDAY, Aug. 6, 2025 (HealthDay News) — In patients with high-risk obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) improves cardiovascular outcomes, while harm may be seen in those with low-risk OSA, according to a study published online Aug. 5 in the European Heart Journal.
Ali Azarbarzin, Ph.D., from Harvard Medical School in Boston, and colleagues conducted a post-hoc analysis of randomized trials to examine whether the cardiovascular benefit of CPAP occurs preferentially in high-risk OSA, characterized by greater OSA-related heart rate acceleration or hypoxemia. The researchers examined the CPAP treatment effect on major adverse cardiovascular and cerebrovascular events (MACCE) for high-risk OSA and evaluated the difference versus low-risk OSA.
Overall, 16.6 and 16.3 percent of participants reached the MACCE end point with CPAP and usual care (1,778 and 1,771 participants, respectively). The researchers found that for participants with versus without high-risk OSA, the CPAP treatment effect was greater (interaction hazard ratio, 0.69). A stronger differential effect was seen for those without excessive sleepiness or without increased blood pressure (interaction hazard ratios, 0.59 and 0.54, respectively). Benefits of CPAP in high-risk OSA were seen alongside harm for those with low-risk OSA.
“For clinicians and policymakers, this means we may need to rethink current guidelines for treating nonsleepy patients and consider focusing treatment for cardiovascular risk reduction on those who stand to gain the most,” Azarbarzin said in a statement. “We also need to be cautious about using CPAP in people who don’t have high-risk markers, as they may not benefit and could even be harmed.”
Several authors disclosed ties to the biopharmaceutical industry.
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