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Treatment of obstructive sleep apnoea as primary or secondary prevention of cardiovascular disease

where do we stand now?

Drager, Luciano F.a,b; Lee, Chi-Hangc

Current Opinion in Pulmonary Medicine: November 2018 - Volume 24 - Issue 6 - p 537–542
doi: 10.1097/MCP.0000000000000523
SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Brian D. Kent

Purpose of review The aim of this study was to provide an update of the primary and secondary prevention of obstructive sleep apnoea (OSA) treatment on cardiovascular disease.

Recent findings Consistent evidence suggest that OSA can contribute to cardiovascular diseases, including hypertension, atrial fibrillation, coronary artery disease and stroke. In patients with no previous history of cardiovascular events (primary prevention scenario), observational studies suggest that continuous positive airway pressure (CPAP), the main treatment for OSA, is able to prevent hypertension incidence and to decrease nonfatal cardiovascular events in men and fatal cardiovascular events in men, women and elderly. In patients with a previous history of cardiovascular events (secondary prevention scenario), recent randomized trials showed that CPAP was not able to prevent a new cardiovascular event. These findings may suggest that in patients with high cardiovascular risk and multiple comorbidities, OSA may not have an incremental role on cardiovascular disease. However, a subanalysis from the same trials showed that good CPAP compliance was able to prevent cerebrovascular events.

Summary OSA may predispose to cardiovascular disease, but additional efforts for improving CPAP use or development of new treatments may help to understand the magnitude of OSA on cardiovascular disease.

aHypertension Unit, Heart Institute (InCor)

bHypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil

cDepartment of Cardiology, National University Heart Centre, Singapore, Singapore

Correspondence to Dr Luciano F. Drager, Hypertension Unit – Heart Institute (InCor), University of Sao Paulo Medical School, Avenida Dr Eneas Carvalho de Aguiar, 44, CEP 05403-900 Sao Paulo, Brazil. Tel: +55 11 26615084; fax: +55 11 26615948; e-mail: luciano.drager@incor.usp.br

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