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CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea: Results of the SAVE Trial

Obstructive sleep apnea (OSA) has long been associated with an increased risk of cardiovascular disease. In particular, both physiological and epidemiological studies have shown significant independent associations between OSA and hypertension1,2, coronary artery disease3, cardiac arrhythmias4, stroke3,5 and heart failure6. Importantly, longitudinal cohort studies have also reported that patients with OSA have a 2- to 3-fold increased risk of all-cause mortality, which is predominantly a cardiovascular-specific death7-9.

While observational studies have suggested that the main treatment for OSA, continuous positive airway pressure (CPAP) therapy, is capable of reducing the risk of both fatal and non-fatal cardiovascular events7, there has been a paucity of large randomized clinical trials specifically designed to demonstrate this finding.

In this podcast, Dr. Bradley Edwards and Associate Professor Garun Hamilton speak with Prof. Doug McEvoy, the lead investigator of a multi-national randomized clinical trial known as the “The Sleep Apnea Cardiovascular Endpoints (SAVE) trial, the results of which have now been reported in the New England Journal of Medicine10. This trial aimed to determine whether CPAP therapy can reduce cardiovascular–related morbidity and mortality in patients with moderate-to-severe OSA and pre-existing cardiovascular disease by randomizing patients to receive CPAP plus usual care (intervention group) or usual care alone (control group) . Together with Drs Edwards and Hamilton, Prof. McEvoy discusses the results of the trial, considers possible reasons for the study findings, and suggests his recommendations for the treatment of patients with OSA and CV disease.

Presenter Disclosures

Bradley Edwards: No relevant commercial interests.
Garun Hamilton: Has received equipment to support research from Resmed, Philips Respironics and Air Liquide Healthcare
Doug McEvoy: Has received research funding from Philips Respironics and Fisher&Paykel and equipment to support research from ResMed and AirLiquide,

 

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References:

  1. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. Jama. Apr 12 2000;283(14):1829-1836.

  2. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. The New England journal of medicine. May 11 2000;342(19):1378-1384.

  3. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. Jan 2001;163(1):19-25.

  4. Mehra R, Stone KL, Varosy PD, et al. Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study. Archives of internal medicine. Jun 22 2009;169(12):1147-1155.

  5. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. The New England journal of medicine. Nov 10 2005;353(19):2034-2041.

  6. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. Oct 1999;160(4):1101-1106.

  7. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. Mar 19-25 2005;365(9464):1046-1053.

  8. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. Aug 1 2008;31(8):1079-1085.

  9. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. Aug 1 2008;31(8):1071-1078.

  10. McEvoy RD, Antic NA, Heeley E, et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. The New England journal of medicine. Sep 8 2016;375(10):919-931.