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. 2024 Jun 1;20(6):895-909.
doi: 10.5664/jcsm.11030.

Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review

Ethan M Balk  1 , Gaelen P Adam  1 , Wangnan Cao  1 , Monika Reddy Bhuma  1 , Carolyn D'Ambrosio  2 , Thomas A Trikalinos  1
Affiliations

Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review

Ethan M Balk et al. J Clin Sleep Med. .

Abstract

Study objectives: We performed a systematic review of long-term health outcomes of continuous positive airway pressure (CPAP) use in adults with obstructive sleep apnea.

Methods: We updated prior systematic reviews with searches in multiple databases through January 3, 2023. We included randomized controlled trials (RCTs) and adjusted nonrandomized comparative studies that reported prespecified long-term (mostly > 1 year) health outcomes. We assessed risk of bias, conducted meta-analyses, and evaluated strength of evidence.

Results: We found 38 eligible studies (16 trials, 22 observational). All conclusions were of low strength of evidence given study and data limitations. RCTs found no evidence of effect of CPAP on mortality (summary effect size [ES] 0.89; 95% confidence interval [CI] 0.66, 1.21); inclusion of adjusted nonrandomized comparative studies yields an association with reduced risk of death (ES 0.57; 95% CI 0.44, 0.73). RCTs found no evidence of effects of CPAP for cardiovascular death (ES 0.99; 95% CI 0.64, 1.53), stroke (ES 0.99; 95% CI 0.73, 1.35), myocardial infarction (ES 1.05; 95% CI 0.78, 1.41), incident atrial fibrillation (ES 0.89; 95% CI 0.48, 1.63), or composite cardiovascular outcomes (all statistically nonsignificant). RCTs found no evidence of effects for incident diabetes (ES 1.02; 95% CI 0.69, 1.51) or accidents (all nonsignificant) and no clinically significant effects on depressive symptoms, anxiety symptoms, or cognitive function.

Conclusions: Whether CPAP use for obstructive sleep apnea affects long-term health outcomes remains largely unanswered. RCTs and nonrandomized comparative studies are inconsistent regarding the effect of CPAP on mortality. Current studies are underpowered, with relatively short duration follow-up and methodological limitations.

Citation: Balk EM, Adam GP, Cao W, Bhuma MR, D'Ambrosio C, Trikalinos TA. Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review. J Clin Sleep Med. 2024;20(6):895-909.

Keywords: cardiovascular disease; clinical outcomes; continuous positive airway pressure device; meta-analysis; obstructive sleep apnea; systematic review.

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Conflict of interest statement

The authors report no conflicts of interest. Carolyn D’Ambrosio is an advisor for Hicuity Health Inc., a triage leader for Dynamed Inc., and holds a patent for a circadian programming device (patent no. 8,979,913). This project was funded under contract no. 290-2015-00002-I/75Q80119F32017 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services (HHS). The authors of this manuscript are responsible for its content. Statements in this manuscript do not necessarily represent the official views of or imply endorsement by AHRQ or HHS. Representatives from AHRQ served as the Contracting Officer’s Technical Representatives and provided technical assistance during the conduct of the full evidence report and provided comments on protocol development and draft versions of the full evidence report. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis or interpretation, or preparation, review, or approval of the manuscript for publication. The Centers for Medicare and Medicaid Services (CMS) nominated the systematic review to AHRQ, which selected the topic for systematic review by an Evidence-based Practice Center. Representatives from CMS provided extensive input during protocol development and the conduct of the full evidence report and provided comments on draft versions of the full evidence report that formed the basis for this manuscript. CMS did not directly participate in the literature search, determination of study eligibility criteria, data analysis or interpretation, or preparation, review, or approval of the manuscript for publication.

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