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Treating Obstructive Sleep Apnea with CPAP: Looking at Long-Term Cardiovascular Effects
Clinical Corner this week features a summary of a ten-year study looking at obstructive sleep apnea’s role as a risk factor for cardiovascular disease, as well as the effectiveness of using continuous positive air pressure (CPAP) for treatment.
Read on to find out more...
SUMMARY OF:
Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnea with or without treatment with continuous positive airway pressure: an observational study.
http://www.ncbi.nlm.nih.gov/pubmed/15781100
Authors: Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Published in: Lancet; Year: 2005; Volume: 36; Pages: 1046-1053.
This study followed a group of 1651 adult men referred to a sleep disorders clinic over ten years to assess the effect of obstructive sleep apnea (OSA) as a risk factor for cardiovascular disease and to evaluate the effect of using CPAP on this risk.
The men were divided into five groups: 264 healthy men without OSA or snoring, 377 snorers without OSA, 403 with untreated mild to moderate OSA, 235 with untreated severe OSA and 372 with treated OSA.
The authors of the study saw patients yearly and looked for both non-fatal cardiovascular events such as heart attacks, strokes, patients needing angioplasty or coronary artery bypass surgery as well as fatal heart attacks or strokes. They found that the risk of fatal and non-fatal cardiovascular events in the patients with untreated severe OSA was approximately three times higher than in all of the other groups. They also found that among patients whose OSA was treated by CPAP, the risk for fatal and non-fatal cardiovascular events was no different than in healthy subjects and snorers without OSA.
The authors of this study concluded that there was an association between OSA and the development of cardiovascular disease that worsens with increasing severity of OSA. In addition, although not entirely clear, it appeared that treatment of severe OSA by CPAP may have reduced the risk of non-fatal and fatal cardiovascular events.
This is a very difficult paper to read, and one can easily get confused by the different patient groups. In any case, they did not specifically examine a treated severe OSA group, but only looked at a treated moderate-severe OSA group, which makes the findings in this group difficult to interpret, since untreated mild to moderate OSA was not associated with an increase in CVD risk.
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