In Patients with Vascular Disease, Treating Sleep Apnea Does Not Reduce the Risk of Cardiovascular Events


Am Fam Physician. 2017 Jan 15;95(2):123.

Clinical Question

Does the use of continuous positive airway pressure (CPAP) reduce the likelihood of cardiovascular events?

Bottom Line

Compared with usual care, the use of CPAP provides a modest improvement in daytime sleepiness, but does not reduce the likelihood of cardiovascular events, even in a high-risk population. (Level of Evidence = 1b)


Because patients with moderate to severe obstructive sleep apnea have frequent episodes of hypoxia, is it possible that those episodes can trigger cardiovascular events? This physiologically plausible hypothesis has been widely considered, and observational studies have provided it with some support, but it has never been tested in a clinical trial. These investigators, mostly from Australia and China, recruited patients 45 to 75 years of age with known coronary artery or cerebrovascular disease and moderate to severe obstructive sleep apnea. The latter was defined as at least 12 drops per hour in the oxygen saturation of at least 4%. Patients with severe daytime sleepiness, very severe hypoxemia, or Cheyne-Stokes respirations were excluded. Although patients knew whether they were using CPAP, outcomes were adjudicated by masked outcome assessors.

The mean age of the 2,687 participants was 61 years, most were men, and the mean body mass index was 29 kg per m2. They were randomized to use CPAP or to continue usual care. At the end of follow-up (mean = 3.7 years), there was no difference between groups in the composite outcome of cardiovascular death, myocardial infarction, stroke, acute coronary syndrome, hospitalization for heart failure, or transient ischemic attack (17.0% for the CPAP group, 15.4% for the usual care group; P = .34). There was no significant difference in any of the individual outcomes. The CPAP group had greater reductions in sleepiness than the usual care group, approximately 2.5 points on the 24-point Epworth Sleepiness Scale, which is of marginal clinical significance.

Study design: Randomized controlled trial (single-blinded)

Funding source: Industry plus government

Allocation: Concealed

Setting: Outpatient (any)

Reference: McEvoy RD, Antic NA, Heeley E, et al. SAVE Investigators and Coordinators. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–931.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



Want to use this article elsewhere? Get Permissions

More in AFP

Editor's Collections

Related Content

More in Pubmed


Sep 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article