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Does CPAP delay the development of cardiovascular disease in patients with obstructive sleep apnoea hypopnoea?
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  1. N T Ayas1,
  2. G B J Mancini2,
  3. J Fleetham1
  1. 1Sleep Disorders Program and Respiratory Division, University of British Columbia, Vancouver, Canada
  2. 2Cardiology Division, University of British Columbia, Vancouver, Canada
  1. Correspondence to:
    Assistant Professor N T Ayas
    Sleep Disorders Program and Respiratory Division, University of British Columbia, Vancouver, Canada; najib.ayas{at}vch.ca

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Large, long term, randomised clinical trials are needed to establish whether CPAP treatment of patients with OSAH has a cardiovascular benefit

Obstructive sleep apnoea hypopnoea (OSAH) is a common under-recognised disorder characterised by recurrent upper airway collapse during sleep.1 These recurrent episodes of upper airway collapse lead to sleep fragmentation, oxyhaemoglobin desaturation, and excessive daytime sleepiness. OSAH also causes sustained activation of the sympathetic nervous system, systemic inflammation with increased levels of C-reactive protein (CRP) and interleukin 6,2 glucose intolerance, and endothelial dysfunction.3 Many of these physiological/biochemical abnormalities are implicated in the pathogenesis of cardiovascular disease (CVD). Indeed, there are compelling epidemiologic data implicating OSAH in the development of systemic hypertension, myocardial infarction, and cerebrovascular events.

OSAH is an independent risk factor for CVD. In a recent study from the Sleep Heart Health Cohort the prevalence of CVD (including myocardial infarction, angina, coronary revascularization, heart failure, stroke) was 1.42 times greater in patients with OSAH (apnoea hypopnoea index (AHI) >11 events/hour) than in those without OSAH (AHI 0–1.3 events/hour) after controlling for potential confounders.4 Furthermore, in a community based study, patients with moderate to severe OSAH were 2.89 times more likely to develop systemic hypertension over a 5 year period than patients without OSAH.5 Similarly, Mooe et al6 followed 408 subjects with coronary disease diagnosed by cardiac catheterisation. Patients with OSAH had a much higher risk of the composite outcome (death, stroke, transient ischaemic attack, myocardial infarction) than patients without OSAH (26.3% v 16.2%) when followed for an average of 5.1 years.

Continuous positive airway pressure (CPAP) is the primary treatment for OSAH.7 It is very effective in eliminating upper airway collapse during sleep, improving sleep fragmentation, and decreasing daytime sleepiness.8 There are accumulating data that CPAP may reduce risks of CVD …

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