CPAP/BPAP Therapy Applied in Addition to Medical Treatment in Improving Cardiac Complications in Sleep Apnea Patients: A Systematic Review and Meta-Analysis
Abstract
Background: Obstructive sleep apnoea (OSA) is strongly linked to hypertension, arrhythmias, and major adverse cardiovascular events (MACE). Continuous or bilevel positive-airway-pressure therapy (CPAP/BPAP) reverses nocturnal airway collapse and might augment the cardiovascular protection afforded by standard medical care, yet trial results remain conflicting.
Methods: Following PRISMA 2020 guidance, we systematically searched PubMed, CENTRAL, and Google Scholar (2015-2025) for randomized and cohort studies comparing CPAP/BPAP plus usual care with usual care alone in adults with OSA. Dual reviewers extracted study characteristics, cardiac outcomes, and blood-pressure changes. The risk of bias was assessed with the NOS and RoB 2 tool. Random-effects meta-analyses generated pooled risk ratios (RR) for atrial fibrillation (AF) and MACE, and mean differences (MD) for systolic and diastolic blood pressure (BP).
Results: Ten studies (six RCTs, four cohorts) encompassing 4,819 participants (2,469 intervention; 2,350 control) met the inclusion criteria. CPAP/BPAP did not reduce incident AF (RR = 1.14, 95 % CI 0.87–1.49; I² = 0 %) or MACE (RR = 1.03, 95 % CI 0.79–1.36; I² = 0 %). Five studies reporting BP showed no significant change in systolic BP (MD = -0.54 mm Hg, 95 % CI -1.67–0.58; I² = 11 %), but a modest reduction in diastolic BP (MD = -0.85 mm Hg, 95 % CI -1.59 to -0.11; I² = 0 %). Publication bias appeared minimal while adherence data were inconsistently reported.
Conclusions: When added to contemporary medical therapy, CPAP/BPAP confers a small diastolic-pressure benefit but fails to lower AF or MACE in predominantly middle-aged to elderly adults with moderate-to-severe OSA. Cardioprotective gains may depend on sustained nightly use and specific high-risk phenotypes. There is an imperative need to design large adherence-focused trials to clarify the cardiovascular dividend of PAP therapy in the long-term.
