Mortality Upon Early CPAP Cessation
A number of recent studies have argued CPAP has no impact on mortality rates, particularly in relationship to cardiovascular disease. A lot of these studies are misleading, because they do not accurately gauge to what extent the patients are actually using PAP therapy.
In a very new study in Chest, French researchers examined an extremely large cohort to compare two groups of patients, the first who continued use of CPAP and the second who stopped use. Each group comprised ~90K patients, and again this study also suffers from the problem of not gauging how much the CPAP users were actually using CPAP. Nonetheless, they do have accurate information confirming that those in the “cessation” group had in fact terminated CPAP use. Thus, the comparison clearly includes a large group of individuals likely to be using CPAP at some level compared to a group that clearly is no longer using the treatment.
They found the CPAP group had significantly lower rates of all-cause mortality, and they also demonstrated a significantly lower rate of heart failure. Thus, the overall associations appear to be that using CPAP leads to lower death rates and a contributing factor may be that CPAP decreases problems with heart failure.
Despite the large number of cases, this type of methodology cannot prove causality, but it remains impressive that the findings align with most sleep doctors’ clinical experience regarding regular use of CPAP in cardiac patients often yields improvement in cardiovascular function.
Their closing comment: “This study showed that continued use of CPAP during the first year after therapy initiation is associated with a significant reduction in mortality in a large national cohort of patients with OSA compared with CPAP therapy termination. This finding adds to a growing body of evidence for the beneficial effects of CPAP usage on survival.”