Sleep medicine · Does CPAP prevent cardiovascular events?
Sleep Apnea Cardiovascular Endpoints study
| Design | International, open-label, randomised controlled trial |
|---|---|
| Treatment | CPAP plus usual care |
| Control | Usual care alone |
| Population | 2717 adults with moderate-to-severe obstructive sleep apnoea and established cardiovascular disease, most without significant sleepiness |
| Follow-up | Mean 3.7 years |
| Primary endpoint | Composite of cardiovascular death, myocardial infarction, stroke, or hospitalisation for unstable angina, heart failure or transient ischaemic attack |
| Result | Mean CPAP adherence was 3.3 hours per night. The apnoea-hypopnoea index fell from 29.0 to 3.7 events per hour. Despite that, CPAP did not reduce the primary composite endpoint over a mean 3.7 years. Sleepiness, mood and quality of life did improve. |
| Secondary endpoints | Individual cardiovascular endpoints, sleepiness, mood, quality of life, days off work |
Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnoea and established cardiovascular disease.
The trial authors, in the published abstract
The defining negative trial in sleep medicine, and the one whose limitation is always raised: 3.3 hours a night is not a treated patient. It was designed in patients without significant sleepiness, so it does not challenge CPAP for symptomatic disease — only the claim that CPAP is cardiovascular prevention. Barbe 2012 found the same in non-sleepy patients.
McEvoy RD, Antic NA, Heeley E, et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016 Sep 8;375(10):919-31.