CPAP Brings Longer Life for Obese People With Sleep Apnea: Study
There's good news for the millions of obese Americans with sleep apnea: Researchers report the use of the CPAP mask may greatly increase their chances for a longer life.
Use of the continuous positive airway pressure (CPAP) mask was tied to a 62% decline in the odds for death over 11 years of follow-up.
That benefit held even after factoring in health risk factors such as heart disease, weight, diabetes and high blood pressure, said a French team of investigators led by Dr. Quentin Lisan, of the Paris Cardiovascular Research Center.
They noted that prior randomized clinical trials had not been able to find a survival benefit for CPAP, but they now believe those trials were simply too short for the effect to emerge.
In the new study, the benefit to longevity only "appears six to seven years after initiation of CPAP therapy," the team reported in the April 11 issue of the journal JAMA Otolaryngology-Head and Neck Surgery.
An expert who penned an accompanying editorial said the findings should help doctors and patients, because many people with sleep apnea balk at the notion of wearing a mask to bed each night.
"Every knowledgeable sleep specialist has had difficulty in convincing some patients of the need to treat their obstructive sleep apnea with these devices," wrote Dr. Clete Kushida, a sleep medicine researcher at Stanford University in California.
As Kushida noted, more than 55.6 million Americans over the age of 40 are thought to suffer the snoring and repeated nighttime awakenings of obstructive sleep apnea, which is often tied to obesity and age.
Sleep apnea isn't just an annoyance: It's also been tied to higher risks for heart disease, heart failure and stroke.
CPAP is the leading remedy for the condition. But can it actually extend users' lives?
To find out, Lisan's group crunched the numbers from the Sleep Heart Health Study, which began in the late 1990s and has followed more than 6,400 Americans 40 and older for decades. The study was funded by the U.S. National Institutes of Health.
The sub-analysis conducted by the French team focused on 392 participants who were severely obese and were diagnosed with severe obstructive sleep apnea. About four-fifths of the participants were men.
Eighty-one of the participants used CPAP over the 11 years of follow-up, while the other 311 did not.
The study found that the CPAP users cut their odds of dying from any cause over those 11 years by almost two-thirds, compared to nonusers.
Given this finding, the use of the therapy in obese patients "should be pursued and encouraged," Lisan's group concluded.
Two sleep specialists who weren't involved in the study agreed it provides crucial information for patients.
Dr. Homere Al Moutran helps direct otolaryngology at Staten Island University Hospital in New York City. He said the new findings echo those of a prior study published in The Lancet that followed 1,651 patients for a decade.
That study also found that "treatment of sleep apnea with a CPAP mask reduces cardiovascular events significantly," Al Moutran said.
Dr. Steven Feinsilver directs the Center for Sleep Medicine at Lenox Hill Hospital, also in New York City. He said that "although there is good evidence that treatment with CPAP improves some elements of cardiovascular risk, it has been frustratingly difficult to prove that use of CPAP is associated with improvement in mortality."
So, this new data is very welcome, he said.
"The Sleep Heart Health Study is the most important epidemiologic study in the field of sleep medicine, started more than 20 years ago," Feinsilver said. He believes this new analysis "adds to the evidence that obstructive sleep apnea is an important public health problem and that CPAP treatment is an effective treatment measure."
The National Sleep Foundation offers more information on sleep apnea.
SOURCES: Steven Feinsilver, M.D.,director, Center for Sleep Medicine, Lenox Hill Hospital, New York City; HomereAl Moutran, M.D., associate director, otolaryngology, Staten Island University Hospital, New York City; April 11, 2019, JAMA Otolaryngology-Head and Neck Surgery