. 2022 Apr-Jun;15(2):250–258. doi: 10.5935/1984-0063.20220047

Table 2.

Evidence of CPAP effects in cardiovascular diseases.

Cardiovascular disease	Observations made based on CPAP therapeutical effects
Hypertension	Minimum CPAP use of at least 4 hours is able to reduce BP pressure in all profiles of hypertension⁶⁴ CPAP also reduces BP in resistant hypertension patients, with a better response proportional to OSA severity^65-72.
Atrial fibrillation	CPAP reduces AF development risk in 42% and its recurrence (42% vs. 82%)^73-76. CPAP also reduces the risk of progression to permanent AF (HR=0.66)^76,77.
Cerebrovascular disease	A recent RCT indicates that patients who were adherent to CPAP therapy had a lower risk for stroke (HR=0.56) and for composite endpoint of cerebral events (HR=0.52)⁷⁸. These results were not adjusted for multiple testing, and post hoc CPAP dose-response analysis showed no significant associations⁷⁸. A different RCT suggests no benefit of CPAP treatment on cerebrovascular risk reduction⁷⁹.
Atherosclerosis	A RCT showed that CPAP treatment reverses markers of atherosclerosis, decreases carotid intima-media thickness, pulse-wave velocity, C-reactive protein, and catecholamines after 4 months⁸⁰. It is also shown a reduction in tumor necrosis factor-a (TNF-a) and interleukin-6 (IL-6)⁸¹. Withdrawal of CPAP treatment exacerbates endothelial dysfunction in patients with minimally symptomatic OSA^82,83.
Heart failure	CPAP usage shows some positive outcomes, such as improvements in LVEF and pulmonary pressure in 12 weeks. Among patients with LVEF lower than 45%, CPAP led to an improvement in LVEF from 25 to 35% (p<0.001) and reduction in systolic blood pressure by 10mmHg (p=0.03) after a month of treatment^84-86. Nonetheless, this treatment reduces biochemical markers of HF (sympathetic activity)⁸⁷. There are still some questions about the effects of CPAP on the survival rate. Some studies show improvement, as the risk for death and hospitalization was increased in the untreated group (HR=2.03) and in less compliant CPAPtreated patients (HR=4.02) when compared to the compliant CPAP-treated group⁸⁸. Meanwhile, other studies don’t show improvements in this matter^84,89. Still, HF patients with OSA treated with CPAP continue to experience rostral fluid shifts during sleep, increasing neck circumference³¹.

Abbreviations: CPAP = Continuous positive airway pressure; BP = Blood pressure; OSA = Obstructive sleep apnea; AF = Atrial fibrillation; HR = Hazard ratio; RCT = Randomized controlled trial; LVEF = Left ventricular ejection fraction; HF = Heart failure.