- Positive airway pressure (PAP) therapy for central sleep apnea with heart failure (HF) is not tied to reduced cardiac mortality or rehospitalization and has unclear benefit for all-cause mortality.
- This Cochrane review found hints of benefit for QoL.
Why this matters
- Some studies have found a benefit of PAP in this population, whereas others have found increased mortality risk.
- PAP therapy duration, 1-31 months.
- All but 1 trial included only patients with HF with reduced ejection fraction.
- Risk ratios (95% CIs) suggested little benefit of PAP for:
- All-cause mortality: 0.81 (0.54-1.21; 6 studies, 1804 patients; I2, 47%; evidence, very low quality).
- Cardiac-related mortality: 0.97 (0.77-1.24; 5 studies, 1775 patients; I2, 11%; moderate-quality evidence).
- All-cause rehospitalization: 0.95 (0.70-1.30; 5 studies, 1533 patients; I2, 40%; low-quality evidence).
- Cardiac rehospitalization: 0.97 (0.70-1.35; 5 studies, 1533 patients; I2, 40%; low-quality evidence).
- However, QoL scores were better with PAP (low-quality evidence).
- Included 16 randomized controlled trials (n=2125).
- PAP compared with usual care.
- Funding: National Institute for Health Research, UK; Clinical Research Program for Child Health and Development, Japan; others.
- High heterogeneity among studies, which mostly had low-quality or very low-quality evidence, wide confidence intervals, and poor descriptions of design.