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CPAP Fails Again: Treatment Doesn’t Improve Heart Risks

Healthy hearth concept, ear doctor on wood background

We’ve already seen this conclusion before: CPAP treatment may help some aspects of sleep apnea, but it doesn’t ultimately improve heart disease risks. This is the conclusion of a new review of all available data. It shows that although it can improve sleep apnea symptoms, CPAP can’t be shown to improve heart risks.

Randomized Clinical Trial Data Shows Limited Benefit

This new study, published in the Journal of the American Medical Association (JAMA) looked at the data from 10 randomized clinical trials (RCT). The RCT is considered the gold standard of clinical data: it takes people with a condition and randomly assigns them to a treatment or a placebo, then monitors the impact.

The 10 selected clinical trials involved a total of nearly 7300 patients. Looking at the data from these trials, it was shown that CPAP was good at reducing symptoms from sleep apnea, such as daytime sleepiness. But it didn’t improve the risk of major adverse cardiovascular events, such as:

  • Heart attack
  • Hospitalization for heart problems
  • Cardiovascular death
  • All-cause death
  • Acute coronary syndrome
  • Stroke

This study represents the accumulation of the best clinical data available so far about CPAP use, and it confirms earlier findings about the ineffectiveness of CPAP for heart problems.

Compliance Is Likely the Problem

When speaking about the results to Reuters, one of the authors said, “Good adherence is hard to achieve with current therapeutic options for PAP.” Some reviewed studies found that using CPAP for at least four hours a night led to some level of improvement in cardiovascular risk, but these results were not statistically significant.

Compliance with CPAP is an even bigger problem than is commonly represented. The current CPAP standard for compliance is four hours a night on 70% of nights, but there is good evidence to suggest that four hours is just not long enough to get benefit from CPAP treatment. What we really need to determine whether CPAP is effective, is studies based on much higher compliance rates with 6 hours or more of treatment overnight.

Now that we have compliance recording for oral appliances, we know that oral appliances can deliver this level of adherence. Now we just need studies to show what impact this has on cardiovascular and other risks.

Is CPAP Over?

The new data is certainly bad news for CPAP. Researchers conclude “Based on the available evidence, it is reasonable to recommend PAP therapy for the improvement of symptoms in patients with obstructive sleep apnea (OSA) but not for protection against vascular disease or death.” With all the nuisance and expense of CPAP, it’s hard to believe that anyone would suffer it for a minor reduction of symptoms.

However, it may be premature to count CPAP out just yet. In an accompanying editorial, a doctor notes that it’s really too soon to say whether CPAP improves cardiovascular risks or not. This study is the best summary of the data available, but the data isn’t all that good. The conclusions are better to temper enthusiasm for CPAP and spur research into better methods than to make people abandon CPAP.

For people who can comply with CPAP and find it works for them, there’s no reason not to keep doing it. But for people who have a hard time using it, it seems more important to get another treatment that they will use.

If you are looking for more information about CPAP alternatives in Omaha, please call (402) 493-4175 today for an appointment with sleep dentist Dr. Roger Roubal at the Advanced Dental Sleep Treatment Center.