Treating obstructive sleep apnea yields little benefit in some patients with ACS

  • Sánchez-de-la-Torre M & al.
  • Lancet Respir Med
  • 12.12.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In patients with acute coronary syndrome (ACS) who have obstructive sleep apnea (OSA) but do not complain of sleepiness, continuous positive airway pressure (CPAP) yields no cardiovascular (CV) event reduction benefit.
  • The apnea was also not associated with CV event risk in this study.

Why this matters

  • These authors say that their findings help explain the “observed neutral effect” of using CPAP for OSA in the setting of secondary prevention.

Key results

  • Event rates did not differ with CPAP vs usual care:
    • 16% vs 17%.
    • HR, 0.89 (95% CI, 0.68-1.17; P=.40).
  • Annual event rate:
    • With CPAP: 7.18 per 100 person-years.
    • With usual care: 7.78 per 100 person-years.
    • Relative risk: 0.92 (0.74-1.15; P=.47).
  • Adherence to CPAP also made no difference.

Study design

  • Multicenter, open-label, parallel-group, randomized controlled trial, 15 hospitals in Spain.
  • 2551 initially enrolled patients (mean age, 60 years) were randomly allocated to CPAP or usual care.
  • Funding: ResMed (Australia); the Spanish Respiratory Society; others.

Limitations

  • Patients with severe ACS or cardiogenic shock were not included.
  • Included only nonsleepy patients with OSA.