#218 CPAP—Breath of life, or just hot air?

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- Three meta-analyses of randomized controlled trials (RCTs).1,2,3 Patients were predominantly male, mean age >60 years, with moderate-to-severe obstructive sleep apnea.
- No statistical different in CPAP versus standard care or sham:
- CVD:1-3 7% CPAP versus 8% control (seven trials, 4,562 patients).1
- Cardiovascular death:1,2 9% CPAP versus 8% control (seven trials, 5,476 patients).1
- Acute coronary syndrome:1,2 3% CPAP versus 3% control (seven trials, 4,562 patients).1
- Stroke:1-3 4% CPAP versus 4% control (six trials, 4,171 patients).1
- Post-hoc analysis did not identify any significant relationship between CPAP and CVD regardless of apnea severity, length of follow-up, or adherence.1
- Limitations: Included studies somewhat heterogeneous with inclusion of central apnea patients in some outcomes, differences in length of follow-up (2-68 months), and adherence to CPAP (1.4-5.8 hours/night at one year).
- No statistical different in CPAP versus standard care or sham:
- Obstructive sleep apnea is associated with increased risk of CVD and mortality.4,5
- CPAP modestly improves daytime sleepiness by 1.6-3.8 on a 24-point scale, which is likely clinically detectable.6-10
- CPAP is associated with modest improvements in quality of life measures (example ~3.3-9.7 improvement on a 100-point scale)11 with uncertain clinical relevance.
- CPAP significantly decreases blood pressure (mean reduction 2.5 mmHg systolic and 2 mmHg diastolic).12
- Observational data suggests that CPAP use significantly reduces motor vehicle accidents.13 A large RCT (2,717 patients) reports a non-statistically significant trend towards injury reduction (7.4% versus 8.8%, p = 0.06).14