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CPAP versus Oxygen in Obstructive Sleep Apnea
Open accessAbstract
BACKGROUND: Obstructive sleep apnea is associated with hypertension, inflammation, and increased cardiovascular risk. Continuous positive airway pressure (CPAP) reduces blood pressure, but adherence is often suboptimal, and the benefit beyond management of conventional risk factors is uncertain. Since intermittent hypoxemia may underlie cardiovascular sequelae of sleep apnea, we evaluated the effects of nocturnal supplemental oxygen and CPAP on markers of cardiovascular risk. METHODS: We conducted a randomized, controlled trial in which patients with cardiovascular disease or multiple cardiovascular risk factors were recruited from cardiology practices. Patients were screened for obstructive sleep apnea with the use of the Berlin questionnaire, and home sleep testing was used to establish the diagnosis. Participants with an apnea-hypopnea index of 15 to 50 events per hour were randomly assigned to receive education on sleep hygiene and healthy lifestyle alone (the control group) or, in addition to education, either CPAP or nocturnal supplemental oxygen. Cardiovascular risk was assessed at baseline and after 12 weeks of the study treatment. The primary outcome was 24-hour mean arterial pressure. RESULTS: Of 318 patients who underwent randomization, 281 (88%) could be evaluated for ambulatory blood pressure at both baseline and follow-up. On average, the 24-hour mean arterial pressure at 12 weeks was lower in the group receiving CPAP than in the control group (-2.4 mm Hg; 95% confidence interval [CI], -4.7 to -0.1; P=0.04) or the group receiving supplemental oxygen (-2.8 mm Hg; 95% CI, -5.1 to -0.5; P=0.02). There was no significant difference in the 24-hour mean arterial pressure between the control group and the group receiving oxygen. A sensitivity analysis performed with the use of multiple imputation approaches to assess the effect of missing data did not change the results of the primary analysis. CONCLUSIONS: In patients with cardiovascular disease or multiple cardiovascular risk factors, the treatment of obstructive sleep apnea with CPAP, but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure. (Funded by the National Heart, Lung, and Blood Institute and others; HeartBEAT ClinicalTrials.gov number, NCT01086800 .).
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In the citing paper
“Treatment of obstructive sleep apnea may reduce blood pressure and have other beneficial cardiometabolic effects”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [152]
In the citing paper
“Although most (but not all) studies and the above meta-analysis support a modest effect of CPAP on blood pressure, the effect on biomarkers associated with cardiovascular risk such as C-reactive protein has been more variable.”
From Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association (2016) · cites this paper as [165]
In the citing paper
“Correction of sleep apnea with CPAP reduces BP in those who are adherent; however, because the SBP reduction is only from 2 to 5 mm Hg, adjunctive medications are almost always needed.260”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [260]
In the citing paper
“It is also important to note that OSA-associated hypertension is only slightly reduced by continuous positive airway pressure (CPAP) treatment.260”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [260]
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Cites
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993) · New England Journal of Medicine · doi:10.1056/nejm199304293281704 · Cited by 10,183
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Self-citationProspective Study of the Association between Sleep-Disordered Breathing and Hypertension
Peppard, P. E., Young, T., Palta, M., & Skatrud, J. (2000) · New England Journal of Medicine · doi:10.1056/nejm200005113421901 · Cited by 4,973
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Nieto, F. J. (2000) · JAMA · doi:10.1001/jama.283.14.1829 · Cited by 3,369
Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
Yaggi, H. K., Concato, J., Kernan, W. N., Lichtman, J. H., Brass, L. M., & Mohsenin, V. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043104 · Cited by 3,004
Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome
Netzer, N. C., Stoohs, R. A., Netzer, C. M., Clark, K., & Strohl, K. P. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-131-7-199910050-00002 · Cited by 2,973
Law, M. R., Morris, J. K., & Wald, N. J. (2009) · BMJ · doi:10.1136/bmj.b1665 · Cited by 2,775
Gottlieb, D. J., Yenokyan, G., Newman, A. B., O'Connor, G. T., Punjabi, N. M., Quan, S. F., Redline, S., Resnick, H. E., Tong, E. K., Diener-West, M., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.901801 · Cited by 1,551
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Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study
Heinzer, R., Vat, S., Marques-Vidal, P., Marti-Soler, H., Andries, D., Tobback, N., Mooser, V, Preisig, M., Malhotra, A., Waeber, G., et al. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00043-0 · Cited by 2,481
CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea
McEvoy, R. D., Antic, N. A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., Mediano, O., Chen, R., Drager, L. F., Liu, Z., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1606599 · Cited by 2,101
Self-citationDiagnosis and Management of Obstructive Sleep Apnea: A Review
Gottlieb, D. J., & Punjabi, N. M. (2020) · JAMA · doi:10.1001/jama.2020.3514 · Cited by 1,482
Self-citationCarey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000084 · Cited by 1,153
St-Onge, M.-P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., & Bhatt, D. L. (2016) · Circulation · doi:10.1161/cir.0000000000000444 · Cited by 1,044
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Metadata
- Authors
- Gottlieb, D. J., Punjabi, N. M., Mehra, R., Patel, S. R., Quan, S. F., Babineau, D. C., Tracy, R. P., Rueschman, M., Blumenthal, R. S., Lewis, E. F., Bhatt, D. L., & Redline, S.
- Affiliations
- Boston University (US)
- Johns Hopkins University (US)
- Cleveland Clinic (US)
- Brigham and Women's Hospital (US)
- Case Western Reserve University (US)
- University of Vermont (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-06-12
- Volume
- 370
- Issue
- 24
- Pages
- 2276-2285
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4172401
- OpenAlex
- W2132646664
- Cited by
- 366
- References
- 44
- Citations by year
- 2026: 24 · 2025: 20 · 2024: 19 · 2023: 15 · 2022: 28 · 2021: 37 · 2020: 23 · 2019: 36 · 2018: 33 · 2017: 31 · 2016: 42 · 2015: 41 · 2014: 16
- FWCI
- 28.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR001079, UL1TR000439)
- National Heart, Lung, and Blood Institute (R21HL108226, R01HL109493, RC2HL101417)
- National Center for Research Resources (UL1RR024989)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- obstructive sleep apnea, continuous positive airway pressure, blood pressure, cardiovascular risk, ambulatory blood pressure, intermittent hypoxemia, cardiovascular disease, hypertension, home sleep testing, Berlin questionnaire
- MeSH terms
- Aged, Hypoxia, Blood Pressure, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Oxygen Inhalation Therapy, Risk Factors, Sleep, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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