NEW research has shown that using continuous positive airway pressure (CPAP) to treat obstructive sleep apnoea (OSA), lowers the risk of serious cardiovascular events in some patients, but may increase the risk of cardiovascular events in others, with researchers calling for a more personalised approach to treating OSA.

The study, which was published in the European Heart Journal, analysed the results of three separate trials involving around 3,500 people with confirmed OSA, of whom half used CPAP.

Patients were followed up for an average of three years and any heart attacks, stokes or deaths from cardiovascular disease were recorded.

Previously, these trials studied the overall effect of CPAP without considering the fact that in some people, OSA causes severe drops in the level of oxygen in the blood or large surges in heart rate, known as high-risk OSA, but in others it does not.

In the new study, the researchers’ analysis revealed that in patients with high-risk OSA, CPAP lowered the risk of heart attack, stroke and death from cardiovascular disease by around 17%, whereas for those without high-risk OSA, CPAP appeared to increase the risk of serious cardiovascular events by around 22%.

When researchers looked only at patients who did not feel sleepy during the daytime, these findings were even stronger – CPAP lowered cardiovascular risk by 24% in high-risk OSA but increased cardiovascular risks in the non-high-risk patients by 30%.

“Our findings suggest that CPAP may offer long-term cardiovascular benefit in people with high-risk OSA but may have unintended harmful effects in those without high-risk OSA,” said study lead Dr Ali Azarbarzin from Brigham and Women’s Hospital and Harvard Medical School.

“For people with high-risk OSA, CPAP likely helps by preventing low oxygen levels and calming the overactive sympathetic nervous system during sleep – both of these are linked to cardiovascular disease.

“But in people without these high-risk markers, who are already at very low cardiovascular risk, CPAP seems to have downsides.”

The researchers could only speculate as to why that might be the case, and said more research is needed to understand the mechanisms behind it.

Read the full paper HERE. KB

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