Continuous positive airway pressure (CPAP) therapy plus usual care may not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease when compared to usual care alone, according to results from the SAVE Trial presented Aug. 28 at ESC Congress 2016 in Rome and published simultaneously in the New England Journal of Medicine.

The trial, led by R. Doug McEvoy, MD, et al., looked at 2,717 patients between 45 and 75 years of age who received CPAP therapy plus usual care vs. usual care alone. Results showed that after a mean follow-up of 3.7 years, the primary composite end point – death from any cardiovascular cause, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack – occurred in 229 patients in the CPAP group vs. 207 patients in the usual care group (hazard ratio with CPAP, 1.10; 95 percent confidence interval, 0.91 to 1.32; P=0.34).

The authors add that they found CPAP therapy “significantly reduced sleepiness and other symptoms of obstructive sleep apnea and improved quality-of-life measures.” However, they ultimately conclude that the use of CPAP therapy “had no significant effect on the prevention of recurrent serious cardiovascular events.”

In a related editorial comment, Babak Mokhlesi, MD, and Najib T. Ayas, MD, MPH, are cautious of the findings and point to the mean duration of CPAP, timing of CPAP, and limited resources at participating sites that may have affected CPAP therapy adherence, among other limitations. “Whether increased adherence to CPAP therapy can lead to better cardiovascular outcomes requires further investigation,” they conclude. 

Keywords: Angina, Unstable, Cardiovascular Diseases, Continuous Positive Airway Pressure, Coronary Artery Disease, ESC Congress, Heart Failure, Ischemic Attack, Transient, Metabolic Syndrome, Myocardial Infarction, Myocardial Revascularization, Secondary Prevention, Sleep Apnea, Obstructive, Stroke

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