PAP Termination in OSA Associated With Risk for Adverse CV Events

In patients with obstructive sleep apnea (OSA), terminating positive airway pressure (PAP) treatment was associated with increased risk for major adverse cardiovascular (CV) events compared with continuing with PAP treatment, according to study findings published in Thorax.

Researchers analyzed data from the Pays de la Loire Sleep Cohort. Participants were aged 18 years and older with newly diagnosed moderate-to-severe OSA and had started PAP treatment at home from May 15, 2007, to December 31, 2018. The primary composite outcome was major adverse CV events (MACE), which was defined as the first occurrence of hospitalization for coronary arterial diseases (CAD), stroke, exacerbation of congestive heart failure (HF), or all-cause death. The patients were followed from PAP initiation through December 2022 or occurrence of a primary outcome.

Among 5138 patients prescribed PAP therapy, 3385 continued on PAP; of those, 2703 with PAP adherence at least 4 hours/night were included in the PAP continuation group. Of the 1753 patients who discontinued PAP during follow-up, 1485 were included in the PAP termination group. Overall, most participants were men (69.6%), and their median age was 58 years.

The median follow-up was 8 (interquartile range, 6-10) years. A total of 969 patients had a MACE (incidence rate ratio [IRR], 29.9; 95% CI, 28.0-31.7), 538 died (IRR, 15.3; 95% CI, 14.0-16.5 per 1000 person-years), and 759 had nonfatal CV events (IRR, 22.2; 95% CI, 19.6-24.9 per 1000 person-years), including 172 strokes (IRR, 5; 95% CI, 4.2-5.7 per 1000 person-years), 293 with CAD (IRR, 8.6; 95% CI, 7.7-9.6 per 1000 person-years), and 294 HF exacerbations (IRR, 8.6; 95% CI, 7.7-9.6 per 1000 person-years).

PAP termination was associated with an increased risk of MACE (unadjusted hazard ratio [HR], 1.19; 95% CI, 1.03-1.38; P =.0159), which continued to be significant after adjustment for confounders (adjusted HR, 1.39; 95% CI, 1.20-1.62; P <.0001).

In analyses in which all-cause mortality and nonfatal CV morbidity were considered separately, PAP termination was associated with a higher risk of all-cause mortality (HR, 1.65; 95% CI, 1.36-1.99; P <.0001) and stroke (subdistribution HR, 1.52; 95% CI, 1.07-2.15; P =.02). A trend for a significant increase was found in nonfatal CV events (subdistribution HR, 1.20; 95% CI, 0.99-1.45; P =.06). PAP termination did not have a significant association with CAD and HF.

No significant difference occurred in the association between PAP termination and MACE risk according to age, sex, history of cardiovascular disease, and symptom subtypes in subgroup analyses.

Limitations include the observational design, and the potential for unmeasured confounding factors such as nutrition, physical activity, and sleep duration to have affected MACE incidence in the PAP termination group. Also, precise data were lacking on the specific causes of death.

“PAP termination compared with adherent PAP continuation was associated with an increased risk of MACE,” the study authors concluded. “More research is needed to determine whether support programmes on PAP adherence could improve CV outcomes.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Pulmonology Advisor