Milan | According to a study, patients with obstructive sleep apnea (OSA) can lower their risk of dying from cardiovascular disease by sleeping with a continuous positive airway pressure (CPAP) machine.
People with OSA snort frequently, their breathing stops and starts throughout the night, and they may wake up several times. This can cause weariness by reducing the amount of oxygen in the blood. It can also increase your chances of developing hypertension, stroke, heart disease, and type 2 diabetes.
CPAP machines are provided to people with OSA to help them sleep better.
During the night, they blow air through a face mask to keep the user's airways open. However, research on the impact of CPAP on cardiovascular disease has shown contradictory results.
The heart disease study was presented by Dr Jordi de Batlle of the Institut de Recerca Biomèdica de Lleida (IRBLleida) in Lleida, Spain. He and his colleagues identified all 3,638 OSA patients in Catalonia who had elected to stop using CPAP in 2011. They compared these to 3,638 OSA patients who used CPAP until at least 2015 or until they died.
Dr de Batlle said, “Our results suggest that CPAP treatment can help most OSA patients by preventing cardiovascular problems such as heart disease and stroke. This is a plus, as CPAP treatment already helps most OSA patients by reducing sleepiness and improving their quality of life. Based on these findings, we should encourage people with OSA to keep using their CPAP machines.”
The pilot study was presented by Dr Cliona O’Donnell, a specialist registrar in respiratory medicine at St. Vincent’s University Hospital and University College Dublin, Ireland. She and her colleagues conducted a study with 30 patients suffering from OSA who underwent a computerised tomography (CT) coronary angiogram to assess any signs of narrowing in the blood vessels that supply the heart.
The patients were then randomly assigned to 24 weeks of treatment either using a CPAP machine at night, injections with the weight loss drug liraglutide, or both together.
Patients who showed signs of coronary artery disease in their first scan
underwent a repeat scan at the end of the 24 weeks of treatment. Researchers used an artificial intelligence program to analyse the patients’ scans.
The patients who were treated with CPAP and those treated with CPAP and weight loss injections experienced reductions in the plaque build-up in their arteries and a reduction of inflammation in their aorta (the main artery that carries blood from the heart to the rest of the body). Patients who were treated with weight loss injections only did not experience these effects.
Dr O’Donnell said, “Continuous positive airway pressure works by keeping patients’ airways open while they sleep. This stops fluctuations in oxygen levels in the blood that can exacerbate cardiovascular disease.
“Although this is a pilot study, meaning we cannot draw firm conclusions, we found improvements in some early signs of cardiovascular disease with CPAP treatment. This should now be further evaluated in larger studies.”
Professor Sophia Schiza, who is secretary of the European Respiratory Society’s group assembly on sleep-disordered breathing and was not involved in the research, said, “We know that people with obstructive sleep apnoea are at a higher risk of cardiovascular problems, but there are conflicting data on the effects of CPAP on reducing this risk.
However, research using real-world data shows that CPAP adherence is one of the key predictors for reducing cardiovascular risk and for better outcomes in general. Here we have two studies: one large study showing that CPAP could help lower the risk of developing or dying from cardiovascular disease in people suffering from OSA and another small study suggesting that CPAP could be more beneficial than weight-loss therapy for people suffering from OSA.
OSA is an extremely common disease, with consequences for people’s daytime functioning and the health of their hearts, blood vessels and metabolism.
One of the treatment options is CPAP, and the more the patients use CPAP every night, the greater the reduction in cardiovascular illness and death. Therefore, there is a need for individualised treatment plans, patient engagement, educational activities and close treatment follow-up in order to increase adherence to long-term treatment and improve outcomes for patients.”