Coronary disease & ACSMeta-analysis
Cardiovascular benefit of continuous positive airway pressure according to high-risk obstructive sleep apnoea: a multi-trial analysis
- Post hoc pooled analysis of randomised trials (RICCADSA, ISAACC, SAVE)
- subgroup analysis
- Cox mixed models
Authors' conclusion
Continuous positive airway pressure preferentially improves cardiovascular outcomes in high-risk OSA, while harm in low-risk OSA may counteract this effect.
Study context
- Population
- Patients with CVD and obstructive sleep apnoea (OSA) in the pooled RICCADSA, ISAACC and SAVE randomised trialspooled RCTs
- Participants
- 3,549 patients
- Comparison
- Continuous positive airway pressure (CPAP) vs usual care, by high-risk vs low-risk OSA
- CPAPn = 1,778
- Usual caren = 1,771reference
- Outcome
- CPAP effect on MACCE (CV mortality, MI, stroke) within high-risk OSA and the difference vs low-risk status
Pooled result
MACCE: CPAP effect in high-risk vs low-risk OSA
Interaction HR (high-risk vs not high-risk OSA)
.69
95% CI .50-.95
P = 0.024 for interaction
As reported in the abstract
Further pooled results
MACCE, overall
| Outcome | interaction HR (95% CI) |
|---|---|
| MACCE interaction, without excessive sleepiness (Epworth <11) (subgroup) · Nhigh-risk = 1509 | .59 (.41-.84) |
| MACCE interaction, without increased BP (<140/90 mmHg) (subgroup) · Nhigh-risk = 1244 | .54 (.36-.81) |
Original publication
Cardiovascular benefit of continuous positive airway pressure according to high-risk obstructive sleep apnoea: a multi-trial analysis. Eur Heart J. Published 5 August 2025. doi:10.1093/eurheartj/ehaf447
Summarised from the published abstract; every number is checked against it