Background: OSA is a key modifiable risk factor for adverse cardiovascular outcomes and is increasingly prevalent in older populations. PAP improves OSA severity, increases oxygenation, and reduces daytime sleepiness. Its effect on major adverse cardiovascular outcomes remains uncertain.
Dr. Mel L. Anderson
Study design: Retrospective cohort study of the Sleep Heart Health Study.
Setting: Nine existing U.S. epidemiologic studies.
Synopsis: Of the 392 patients analyzed, 81 were prescribed PAP and 311 were not. Investigators controlled for OSA severity, history of stroke or MI, hypertension, diabetes, weight, smoking, and alcohol intake. The adjusted hazard ratio for death at mean 11 years was 42% lower for those prescribed PAP.
Bottom line: PAP markedly lowers mortality in OSA, with survival curves separating at 6-7 years.
Citation: Lisan Q et al. Association of positive airway pressure prescription with mortality in patients with obesity and severe obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 2019 Apr 11. doi: 10.1001/jamaoto.2019.0281.
Dr. Anderson is chief, hospital medicine section, and deputy chief, medicine service, at the Veterans Affairs Eastern Colorado Health Care System, Aurora.