Large real-world study finds CPAP users had fewer costly heart-related emergencies.
By Sree Roy
Summary: A large real-world study presented at SLEEP 2025 found that patients with OSA who consistently used CPAP were significantly less likely to visit the ER or be hospitalized for cardiovascular conditions, and also had lower related healthcare costs.
Key takeaways:
- CPAP-adherent patients had a 22% lower risk of ER visits or hospitalizations for cardiovascular diagnoses than nonadherent patients.
- Even patients with partial CPAP adherence showed reduced events and costs, though not as pronounced.
- The findings underscore that CPAP only provides cardiovascular benefits if patients actually use it as prescribed.
There’s new evidence that CPAP use is linked to a lower chance of obstructive sleep apnea (OSA) patients landing in the emergency room (ER) or being hospitalized for stroke, heart failure, coronary artery disease, arrhythmia, cardiomyopathy, or hypertension.
Presented at SLEEP 2025, a retrospective cohort study funded by Resmed found that CPAP-adherent OSA patients were significantly less likely to have any cardiovascular-related healthcare utilization, with a 22% lower risk of the aforementioned primary diagnoses, compared to nonadherent patients. The study’s large size—377,830 patients with newly diagnosed OSA starting CPAP—and the data being from the real-world (from the years 2015 to 2021) make the study relevant to sleep physicians and their patients.
“In the real world, not just in clinical trials, the therapy does make a difference in patient lives,” says study co-investigator Kimberly Sterling, vice president, medical affairs at Resmed. “And there is this opportunity for the healthcare system to derive cost savings from the use of [C]PAP therapy.”
The study found both cardiovascular events and related healthcare costs were significantly lower among adherent patients—and to a lesser extent, among those with intermediate adherence.
In the two years after a CPAP prescription:
- Cardiovascular-related ER visits were: 2.91 (adherent), 3.34 (intermediate), 3.70 (nonadherent)
- Cardiovascular-related hospitalizations were: 1.53 (adherent), 1.90 (intermediate), 2.09 (nonadherent)
- Composite: 4.09 (adherent), 4.77 (intermediate), 5.22 (non-adherent)
Similarly, cardiovascular-related healthcare spending declined.
- Year before CPAP therapy: $419 (adherent), $424 (intermediate), $436 (nonadherent)
- Year 1 of CPAP: $182 (adherent), $230 (intermediate), $257 (nonadherent)
- Year 2 of CPAP: $166 (adherent), $237 (intermediate), $267 (nonadherent)
Intermediate adherence was defined as patients who met the Centers for Medicare & Medicaid Services compliance threshold at least one, but not all eight quarters studied.
“[C]PAP works when it’s used and used appropriately. But if you never use it, you’ll never receive any of those benefits. But again, the more you use it, the more benefits you do derive,” Sterling observes.
Sterling hopes these findings give physicians and patients additional motivation to achieve consistent CPAP use. She says, “While we definitely want to hear from patients that ‘I feel better on treatment,’ knowing that you have this opportunity to improve overall health and reductions in unnecessary healthcare resource use…that should be motivating for really encouraging adherence and for thinking about treatment options.”
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