SOURCE: Wu X, et al. Chest 2015;1478:708-718.
Obstructive sleep apnea (OSA) is associated with numerous comorbidities and downstream consequences, not the least of which are increased cardiovascular events, hypertension, and arrhythmias. The increased sympathetic tone associated with OSA is usually considered a major culprit in the evolution of such adversities. While the associations between OSA are strong and consistent across numerous reports and diverse populations, outcomes trials showing concrete endpoint reduction through successful treatment of OSA are less evident.
The clinical trial data reported by Wu et al confirm very favorable results in a very specific population: Persons with sleep laboratory-confirmed OSA (n = 390) who had undergone PCI were followed over 4.8 years (median). The primary endpoint of interest was whether treatment of OSA affected the incidence of revascularization compared to untreated OSA. Treatment of OSA by CPAP was confirmed at 3-monthly intervals for the first year, and annually thereafter.
The incidence of coronary revascularization was almost twice as high in the untreated OSA group than in the treated OSA group (26.1% vs 14.1%, P = 0.019). Although there were statistically significant differences between groups as far as overall mortality or cardiovascular events, outcomes at 5 years tended to favor the CPAP-treated OSA patients. OSA treatment reduces the need for revascularization in persons who have undergone PCI.