CPAP therapy reduces all-cause and cardiovascular mortality in OSA patients: Lancet

A new study published in The Lancet Respiratory Medicine journal showed positive airway pressure (PAP) treatment to be associated with reduced mortality rates in obstructive sleep apnea (OSA) patients.

There is conflicting information on how positive airway pressure treatment for obstructive sleep apnea affects mortality from all causes. Adam Benjafield and team therefore set out to explore the hypothesis that PAP treatment is linked to lower cardiovascular and all-cause mortality in individuals with OSA in this systematic review and meta-analysis.

Without regard to language or location, this study conducted a search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials for this systematic review and meta-analysis from the beginning of the database until August 22, 2023 (updated September 9, 2024). Abstracts from recent conferences (2022–2023) and reference lists of relevant works were also examined. This research excluded studies that evaluated only PAP adherence and other study types.

Also, outpatient studies (confounder-adjusted, non-randomized controlled studies [NRCSs] or randomised controlled trials [RCTs]) that assessed the incidence of cardiovascular mortality, all-cause mortality, or both in adults (aged ≥18 years) with OSA who were treated versus not treated with PAP were included. To estimate overall HRs and 95% CIs, this study used a linear random-effects model to analyze each log-transformed hazard ratio (HR) and SE. By employing Newcastle–Ottawa Scale for NRCSs and the Cochrane Risk of Bias tool for RCTs, this study assessed the risk of bias.

A total of 30 studies (ten RCTs and twenty NRCSs) were included in the systematic review and meta-analysis after 435 of the 5484 records found by our search were evaluated for eligibility. These studies comprised 11,75,615 individuals, with a mean age of 59·5 (SE 1·4) years and a mean follow-up of 5·1 (0·5) years.

Of these, 9,05,224 (77%) were male and 2,70,391 (23%) were female (SE 1·9). The bias was a low to moderate risk. The clinically meaningful benefit of PAP treatment increased with usage, and the risk of cardiovascular mortality and all-cause mortality was considerably lower in the PAP group than in the no-PAP group. Overall, these findings supported a possible positive impact of PAP treatment on cardiovascular and all-cause mortality in OSA patients. 

Reference:

Benjafield, A. V., Pepin, J.-L., Cistulli, P. A., Wimms, A., Lavergne, F., Sert Kuniyoshi, F. H., Munson, S. H., Schuler, B., Reddy Badikol, S., Wolfe, K. C., Willes, L., Kelly, C., Kendzerska, T., Johnson, D. A., Heinzer, R., Lee, C.-H., Malhotra, A., & medXcloud Group. (2025). Positive airway pressure therapy and all-cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies. The Lancet. Respiratory Medicine. https://doi.org/10.1016/S2213-2600(25)00002-5