Long-term effect of continuous positive airway pressure on cardiovascular outcomes after acute myocardial infarction in obstructive sleep apnea patients.

PURPOSE: Obstructive sleep apnea (OSA) is highly prevalent in patients with acute myocardial infarction (AMI), contributing to increased cardiovascular risk. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, yet its long-term role in reducing major adverse cardiac and cerebrovascular events (MACCE) remains controversial. This study evaluates the impact of CPAP adherence on long-term cardiovascular outcomes in post-AMI patients with OSA.

METHODS

This retrospective cohort study analyzed electronic health record from Kaiser Permanente Southern California between 2015 and 2019. Adult patients with AMI and a history of OSA were included. Patients were categorized into CPAP-adherent users (≥ 4 h/night; n = 54) and non-adherent users (< 4 h/night; n = 126) during the follow-up period. The primary endpoint was MACCE, a composite of 30-day cardiovascular readmissions, repeat cardiac catheterization, cerebrovascular accident (CVA), congestive heart failure (CHF), recurrent AMI, and mortality. Cox regression models were used to examine the association between CPAP adherence and MACCE.

RESULTS

CPAP adherence was associated with a 51% reduction in MACCE risk (adjusted HR 0.49, 95% CI 0.26–0.92, p = 0.03). Re-catheterization was significantly lower in the CPAP-adherent group (1.9% vs. 11.1%, p = 0.04), while CVA events occurred exclusively in the non-adherent group.

CONCLUSIONS

Adherent CPAP use is significantly associated with lower cardiovascular risk in post-AMI patients with OSA. These findings highlight the potential value of OSA screening and promoting CPAP adherence as part of secondary prevention strategies following AMI. Further prospective studies are needed to validate these results and refine prevention strategies in high-risk populations.