Continuous positive airway pressure treatment improves cardiovascular outcomes in elderly patients with cardiovascular disease and obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is associated with the progression of cardiovascular disease (CVD), particularly in the middle-aged population. However, the clinical importance of OSA as a risk for CVD in the elderly population remains controversial. Moreover, evidence for the effectiveness of continuous positive airway pressure (CPAP) treatment for the secondary prevention of CVD in elderly patients is lacking. We assessed whether CPAP treatment improves cardiovascular outcomes in elderly patients with OSA and CVD. In this retrospective cohort study, we enrolled 130 elderly patients aged 65-86 years with moderate to severe OSA (apnea-hypopnea index ≥15/h) and a history of hospitalization due to CVD, who underwent polysomnography between November 2004 and July 2011. Patients were divided into the CPAP group (n = 64) or untreated OSA group (n = 66). The main outcome measures were cardiovascular death and hospitalization due to CVD. During the mean follow-up period of 32.9 ± 23.8 (standard deviation) months, 28 (21.5 %) patients either died or were hospitalized. The Kaplan-Meier curves indicated that event-free survival was significantly lower in the untreated OSA group than in the CPAP group (P < 0.005). A multivariate analysis showed that the risk was significantly increased in the untreated OSA group (hazard ratio 5.13; 95 % confidence interval 1.01-42.0; P < 0.05). Moderate to severe OSA not treated with CPAP was an independent risk factor for relapse of a CVD event, and adequate CPAP treatment improved cardiovascular outcomes in elderly patients.

Continuous positive airway pressure therapy in non-sleepy patients with obstructive sleep apnea: results of a meta-analysis

“…OSA is associated with increased risk of mortality and cardiovascular events, and observational studies and RCTs have suggested that CPAP treatment reduces the incidence of mortality and non-fatal cardiovascular events in OSA patients (35)(36)(37), especially in those patients with moderate and severe OSA. However, our meta-analysis revealed no significant treatment effect of CPAP on cardiovascular events in nonsleepy OSA patients.…”

Increased Risk for Cancer in Young Patients with Severe Obstructive Sleep Apnea

“…These associations may be due to common risk factors or may reflect an etiologic role of OSAS in pathogenesis [7,12]. Interestingly, there are some indications that treatment of OSAS by continuous positive airway pressure or surgery may also reduce the severity of these morbid conditions [13][14][15].…”

Cardiac structure and function improvements in coronary artery disease combined with severe obstructive sleep apnea/hypopnea syndrome patients via noninvasive positive pressure ventilation therapy

“…Data from observational studies and randomized trials have shown that if diastolic blood pressure decreased 2 mmHg in a population, the prevalence of hypertension would decrease by 17%, the risk of coronary heart disease would decrease by 6%, and the risk of stroke and transient ischemic attack would decrease by 15% [12]. Nishihata et al [13] recently reported that CPAP therapy can improve the outcome of cardiovascular events in elderly patients with heart disease and OSAHS; the authors conducted a survey of the survival and hospitalization rates in 130 patients and found that CPAP therapy improved cardiovascular disease events, a result that is highly consistent with our study. In addition, serum hsCRP concentration decreased significantly, suggesting that when the coronary heart disease/OSAHS patients were treated with noninvasive positive pressure ventilation therapy, less inflammatory mediators were released, thereby reducing blood vessel endothelial dysfunction and ameliorating the myocardial ischemia.…”