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Evidence from observational studies has implicated obstructive sleep apnoea (OSA) as a risk factor for cardiovascular and cerebrovascular mortality. However, such studies have been complicated by the presence of uncontrolled co-factors such as obesity, smoking, and diabetes mellitus and by the absence of randomisation. There has been little evidence of long term benefit in macrovascular risk from the treatment of OSA.
The present study is a longitudinal observational study in men with simple snoring, mild to moderate or severe OSA matched with healthy volunteers followed up annually over 10 years. The results indicate a stepwise increasing risk of macrovascular mortality and morbidity in patients with snoring, mild to moderate and severe OSA (untreated) compared with healthy (age and body mass index matched) volunteers. Interestingly, the incidence of both fatal and non-fatal events in patients on treatment with continuous positive airways pressure (CPAP) was reduced to that observed in simple snorers.
Previous studies have shown a relative increase in cardiovascular mortality in patients with OSA but no difference in overall mortality rates. This longitudinal study provides more evidence of the increased risk of vascular morbidity and mortality in men with snoring and/or OSA (including mild disease), while suggesting a significant survival advantage of treatment with CPAP in severe OSA. Hitherto, evidence of efficacy of CPAP has only been in improving symptoms, but the results of this and similar studies may change the current indication for CPAP prescription from symptomatic relief to risk reduction.