Current Respiratory Medicine Reviews

Joseph Varon  
The University of Texas Health Science Center
Houston, TX


Effectiveness of Nasal Continuous Positive Airway Pressure (CPAP) Therapy on Cardiovascular Outcomes in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Author(s): Jose Cordero-Guevara, Joaquin Teran-Santos, Maria Luz Alonso-Alvarez, Javier Castrodeza-Sanz, Estrella Ordax-Carbajo, Fernando Masa-Jimenez.


Background: There are ethical issues about randomizing individuals with obstructive sleep apnea-hypopnea syndrome (OSAHS) into groups that receive therapy and those that do not, which means that longitudinal studies are necessary. Objective: To evaluate the effectiveness of nasal continuous positive airway pressure (CPAP) therapy on cardiovascular outcomes in OSAHS patients and to discuss the use of OSAHS treatment. Design: A prospective, patient-based study using retrospective observational data was performed. Cox multivariate regression analysis was performed to determine the adjusted effect of CPAP-treatment on survival in cardiovascular events (CVE). Setting: Sleep Unit of Burgos, Spain. Patients: All 887 patients (791 men) with OSAHS were diagnosed by Polysomnography in the Sleep Unit, between 1997 and 2002. Intervention: CPAP-treatment versus non CPAP-treatment, according to Spanish Society of Pulmonary and Thoracic Surgery (SEPAR) criteria. Measurements: The cardiovascular disease data were obtained from hospital records. Results: The average follow-up period was 4.1 years. CPAP-treatment patients had a higher mean apnea-hypopnea index score than the untreated group (45.9 [Standard Deviation (SD): 28.2] versus 25.3 (SD: 17.8), respectively; P < 0.001), as well as a higher Body Mass Index, Epworth and Arousals, but age and sex were similar in both groups. Cardiovascular disease was more common in the untreated group than in the CPAP-treated group during follow-up (3.0 versus 1.99 cardiovascular events/100 persons-years, respectively; P=0.1547). Upon multivariate analysis, age, sex, prior cardiovascular disease, diabetes mellitus and CPAP (hazard ratio= 0.519, 95% confidence interval: 0.288-0.935) remained as statistically significant predictors of survival in cardiovascular events. The mortality rate was greater in women than men. Conclusions: The data support a protective effect of CPAP therapy against cardiovascular disease in patients with OSAHS and different cardiovascular morbidity and mortality by gender. CPAP therapy shows a positive benefit/risk balance.

Keywords: Obstructive sleep apnea, continuous positive airway pressure, cardiovascular diseases, effectiveness treatment, Nasal Continuous Positive Airway Pressure, Obstructive Sleep Apnea- Hypopnea Syndrome, cerebrovascular diseases, atherosclerosis, hypertension, obesity, Clinical variables

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Article Details

Year: 2011
Page: [121 - 129]
Pages: 9
DOI: 10.2174/157339811794927842
Price: $58