Summary: A large meta-analysis on the long-term benefits of CPAP therapy, published in The Lancet Respiratory Medicine, found that in people with sleep apnea, CPAP therapy lowered the overall chance of dying by 37% and the chance of heart-related death by 55%.
Key Takeaways:
- The meta-analysis reviewed data from over 1 million patients with obstructive sleep apnea (OSA), compiling findings from 30 studies, including 10 randomized controlled trials and 20 real-world studies.
- Greater consistency and longer duration of nightly CPAP use are directly correlated with increased survival benefits.
- These findings provide clinicians concrete evidence to motivate patients to start CPAP therapy and to encourage existing users to increase nightly usage.
By Sree Roy
Whether CPAP makes a difference in long-term outcomes for people with obstructive sleep apnea (OSA) has been hotly debated, especially after the Agency for Healthcare Research and Quality (AHRQ) published a report several years ago stating the evidence was inadequate.
If a new AHRQ report was commissioned today, it might come to a different conclusion—in part because of a large meta-analysis published this month in The Lancet Respiratory Medicine, which provides strong evidence that CPAP therapy not only alleviates OSA symptoms (which is not debated) but can also prolong life. The Resmed-sponsored meta-analysis looked at data from over 1 million sleep apnea patients worldwide.
“We know [CPAP] makes people feel better. It’s been associated with improvements in blood pressure and reduced risk of motor vehicle accidents,” said sleep specialist Atul Malhotra, MD, senior author of the study and research chief of Pulmonary, Critical Care, and Sleep Medicine at the University of California San Diego School of Medicine and pulmonologist at UC San Diego Health, during a press briefing about the paper. “But in terms of: Is it saving lives? We didn’t know. That’s why we did this analysis.”
CPAP Meta-Analysis Findings
The meta-analysis pooled data across 30 studies, including 10 randomized controlled trials and 20 real-world evidence studies. Researchers analyzed long-term outcomes over the average follow-up period of nearly five years, testing the hypothesis that CPAP therapy reduces both all-cause and cardiovascular mortality in OSA patients.
The meta-analysis found that people with OSA who use CPAP therapy have:
- A 37% lower risk of dying from any cause compared to those with OSA who do not use CPAP.
- A 55% lower risk of dying from cardiovascular disease.
- A dose-response relationship, meaning that the more consistently CPAP is used, the greater the survival benefits for people living with OSA.
Motivation for Patients to Use CPAP—And Then Use It More
The dose-response findings are particularly compelling.
The dose-response aspect builds on earlier research, noted Carlos Nunez, MD, Resmed’s chief medical officer, during the press briefing. The literature includes a study that found CPAP usage to be linearly linked with a reduced number of inpatient and overall acute care visits, as well as fewer emergency department visits and inpatient stays. As well as a study that provided evidence for a dose-response relationship between CPAP usage and healthcare utilization, with benefits seen even when usage was as low as 1 or 2 hours a night.
“It’s not surprising because we’ve started to see earlier hints that using [CPAP] is good; using it more is better,” Nunez said.
The meta-analysis data resonates with patients, Malhotra has found, and he uses it to motivate patients toward greater CPAP use. “I’ve been telling my patients, ‘Look, there’s an odds ratio of 0.63, meaning there’s a 37% all-cause mortality benefit. If you want to ignore that, that’s up to you. But these are the facts’….
“If I have a patient using it 4 hours per night, I say, ‘That’s great, but how can we get to 5 hours?’ It’s a goal to keep improving.”
Malhotra said advances in CPAP data download transmission also assist the physician with related aspects of patient motivation.
“A lot of it is cloud-based,” he said. “I can track patients quite nicely. When I see them in clinic, I have a printout of how much they are using it, and you can give them really good feedback about if they’re doing well or if there’s room for improvement.”
How the Meta-Analysis Moves Beyond the AHQR Report
In addition to the AHQR report becoming outdated by new research, Malhotra characterizes this CPAP usage meta-analysis very differently.
The AHQR’s “review of the evidence neglected to cover all of the available evidence,” he said. By contrast, the new paper, he says, is a “much more exhaustive, thorough look at the literature than what AHRQ did a number of years ago.”
He also critiqued the AHQR report for being dismissive of the symptom benefits reported by patients who use CPAP. “To trivialize that, I think, was a mistake,” he said.
Another study co-author, Jean-Louis Pépin, a professor of Clinical Physiology at Grenoble University Hospital and director of the HP2 Laboratory INSERM U1300, said in a release that the latest findings “should serve as a wake-up call.”
He said, “Every additional hour of CPAP treatment translates to improved chance of survival for people living with OSA. Patients who stay on CPAP therapy aren’t just breathing easier at night; they’re potentially adding years to their lives.”
