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CPAP Therapy Reduces Cardiovascular Events in High-Risk OSA Patients but Increases Risk in Low-Risk Group

The findings underscore the need for risk-stratified CPAP prescriptions under revised guidelines backed by new prospective trials.

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Overview

  • An individual-patient meta-analysis of 3,549 OSA patients with cardiovascular disease found a 17% reduction in major cardiac events for those with high hypoxic burden or heart-rate spikes using CPAP.
  • The study revealed a 22% rise in cardiovascular events among low-risk patients on CPAP, climbing to a 30% increase in non-sleepy individuals.
  • Data pooled from ISAACC, RICCADSA and SAVE trials over three years highlighted hypoxic burden and heart-rate response as critical markers for treatment stratification.
  • An editorial in the European Heart Journal calls for updates to OSA management guidelines that prioritize personalized, risk-based CPAP use.
  • Investigators led by Ali Azarbarzin are planning a targeted prospective trial to confirm benefits for high-risk patients and explore mechanisms of potential harm in low-risk groups.