Prevention & lipids

Adherence to Continuous Positive Airway Pressure (CPAP) Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis

JAMAPublished Systematic review and individual participant data meta-analysis of randomised trials

Pooled resultResult — go to the resultHazard ratio 1.01 95% CI 0.87–1.17

Authors' conclusion

Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA.

Study context

Population
Adults with CVD and obstructive sleep apnea (OSA) (secondary prevention)Individual participant data (IPD) meta-analysis of SAVE, ISAACC, RICCADSA
Participants
4,186 adults
Comparison
CPAP vs no CPAP
Outcome
First recurrent MACCE
Methodological detailsone-stage and 2-stage IPD meta-analyses, mixed-effect Cox regression, Mean [SD] follow-up 3.25 [1.8] years; mean [SD] CPAP adherence 3.1 {2.4} h/day
  • One-stage and 2-stage IPD meta-analyses
  • Mixed-effect Cox regression
  • Mean [SD] follow-up 3.25 [1.8] years; mean [SD] CPAP adherence 3.1 {2.4} h/day

Pooled result

As reported in the abstract

Hazard ratio

1.01

95% CI 0.87–1.17

CPAPvs No CPAP
HR 1.01 (95% CI 0.87–1.17)

Further pooled results

MACCE with good adherence to CPAP (≥4 h/day)

HR (95% CI)
Good adherence to CPAPOn-treatment analysis0.69 (0.52–0.92)
  • MACCE with good adherence to CPAP (≥4 h/day): marginal structural Cox models with inverse probability of treatment weighting

Original publication

Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis. JAMA. Published 3 October 2023. doi:10.1001/jama.2023.17465

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