Does PAP Therapy Reduce Mortality and Improve QOL in Obstructive Sleep Apnea?

Jun 18, 2024

Photo Credit: Andrey Popov

Positive airway pressure (PAP) therapy can reduce mortality in patients with obstructive sleep apnea, and improve their overall quality of life (QOL).

A systematic review and meta-analysis supports the use of positive airway pressure (PAP) therapy to reduce all-cause mortality in patients with obstructive sleep apnea (OSA). According to the authors, future research should explore causal pathways and effect modifiers for the observed benefit of PAP therapy.

“PAP therapy is the treatment of choice in patients with OSA, delivering marked improvements in patient-reported quality-of-life outcomes,” said Dr. Atul Malhotra, MD, from the University of California San Diego, CA, in the US. “However, the impact of PAP therapy on all-cause mortality in this population is not clear.” The current systematic literature review and meta-analysis evaluated the association between all-cause mortality and PAP therapy in patients with OSA. The authors included 10 randomized trials and 17 non-randomized studies with all-cause mortality as outcome measure, resulting in a total sample size of 1,164,880 patients. In addition, they included 6 randomized-controlled trials and 5 non-randomized-controlled studies with cardiovascular mortality as outcome measure.

Overall, PAP therapy had a significant impact on all-cause mortality in patients with OSA (HR 0.63; 95% CI 0.56–0.72; P<0.001). Dr. Malhotra mentioned that there was a trend towards a better treatment effect if the treatment adherence was higher: the treatment effect was 16% greater in patients using PAP therapy for at least 4 hours per night compared with patients who used PAP therapy for fewer than 4 hours per night. Next, PAP therapy reduced cardiovascular mortality in patients with OSA (HR 0.46; 95% CI 0.29–0.73; P=0.001).

The current study thus indicates that PAP therapy is an effective treatment to reduce all-cause mortality in patients with OSA across diverse populations.

Medical writing support was provided by Robert van den Heuvel.