Cited by 16Obstructive Sleep Apnea ResearchSleep and related disordersRespiratory Support and Mechanisms

Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: A systematic review

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Balk, Ethan M., Adam, Gaelen P., Cao, Wangnan, Bhuma, Monika Reddy, D’Ambrosio, Carolyn, Trikalinos, Thomas A.·2024·Journal of Clinical Sleep Medicine

Abstract

Study objectives We performed a systematic review of long-term health outcomes of continuous positive airway pressure (CPAP) use in adults with obstructive sleep apnea.Methods We updated prior systematic reviews with searches in multiple databases through January 3, 2023. We included randomized controlled trials (RCTs) and adjusted nonrandomized comparative studies that reported prespecified long-term (mostly > 1 year) health outcomes. We assessed risk of bias, conducted meta-analyses, and evaluated strength of evidence.Results We found 38 eligible studies (16 trials, 22 observational). All conclusions were of low strength of evidence given study and data limitations. RCTs found no evidence of effect of CPAP on mortality (summary effect size [ES] 0.89; 95% confidence interval [CI] 0.66, 1.21); inclusion of adjusted nonrandomized comparative studies yields an association with reduced risk of death (ES 0.57; 95% CI 0.44, 0.73). RCTs found no evidence of effects of CPAP for cardiovascular death (ES 0.99; 95% CI 0.64, 1.53), stroke (ES 0.99; 95% CI 0.73, 1.35), myocardial infarction (ES 1.05; 95% CI 0.78, 1.41), incident atrial fibrillation (ES 0.89; 95% CI 0.48, 1.63), or composite cardiovascular outcomes (all statistically nonsignificant). RCTs found no evidence of effects for incident diabetes (ES 1.02; 95% CI 0.69, 1.51) or accidents (all nonsignificant) and no clinically significant effects on depressive symptoms, anxiety symptoms, or cognitive function.Conclusions Whether CPAP use for obstructive sleep apnea affects long-term health outcomes remains largely unanswered. RCTs and nonrandomized comparative studies are inconsistent regarding the effect of CPAP on mortality. Current studies are underpowered, with relatively short duration follow-up and methodological limitations.Citation Balk EM, Adam GP, Cao W, Bhuma MR, D'Ambrosio C, Trikalinos TA. Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review. J Clin Sleep Med. 2024;20(6):895-909.

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  • Observational studies suggest a benefit on health outcomes from CPAP treatment in general populations, which may extend to those with PCOS.

    “The long-term cardiometabolic health benefits for treating OSA with CPAP are also not clearly established from RCTs, but research from observational studies seems to suggest a benefit on health outcomes from treatment in general populations, which may extend to those with PCOS (42).”

    From Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis (2025) · cites this paper as [42]

    The Discussion (page not provided) reports that observational studies associate CPAP with lower all-cause mortality, while emphasizing that this is low-strength evidence and that adding observational studies mostly does not change conclusions for other long-term outcomes. The paper does not address PCOS, so it does not support the suggested extension to that population. (LLM, conf=0.88)

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  • Long-term cardiometabolic health benefits for treating OSA with CPAP are not clearly established from RCTs.

    “The long-term cardiometabolic health benefits for treating OSA with CPAP are also not clearly established from RCTs, but research from observational studies seems to suggest a benefit on health outcomes from treatment in general populations, which may extend to those with PCOS (42).”

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Research works printed but not linked: 1

  1. Balk EM, Adam GP, Cao W, et al. Long-Term Health Outcomes in Obstructive Sleep Apnea: A Systematic Review of Comparative Studies Evaluating Positive Airway Pressure and the Validity of Breathing Measures as Surrogate Outcomes. Rockville, MD: Agency for Healthcare Research and Quality; 2022.

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Authors
Balk, E. M., Adam, G. P., Cao, W., Bhuma, M. R., D’Ambrosio, C., & Trikalinos, T. A.
Affiliations
  • Brown University (US)
  • Yale University (US)
Corresponding author
Balk, Ethan M.
Venue
Journal of Clinical Sleep Medicine
Published
2024-06
Volume
20
Issue
6
Pages
895-909
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
OpenAlex
W4391470679
Cited by
16
References
79
Citations by year
2026: 3 · 2025: 7 · 2024: 6
FWCI
0.91
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agency for Healthcare Research and Quality
Topics
  • Health Sciences › Medicine › Physiology › 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
continuous positive airway pressure, obstructive sleep apnea, long-term health effects, mortality, cardiovascular outcomes, stroke, myocardial infarction, atrial fibrillation, diabetes mellitus, accidents, depressive symptoms, anxiety, cognitive function, mental health
MeSH terms
Humans, Mental Health, Treatment Outcome, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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