A meta-analysis of positive airway pressure treatment for cardiovascular prevention: why mix apples and pears?

Commentary on : Yu J, Zhou Z, McEvoy RD, et al . Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. JAMA 2017;318:156–66. Despite an increasing body of evidence supporting an independent association between sleep apnoea and cardiovascular outcomes, there is still a lack of convincing data to suggest that treating this disorder reduces the cardiovascular risk. Sleep apnoea may be either obstructive (OSA) or central (CSA), or of a combination of both types, especially in patients with concomitant cardiovascular disease (CVD). Randomised controlled trials (RCT) have shown that continuous positive airway pressure (CPAP) treatment reduces excessive daytime sleepiness and improves quality of life in sleepy patients with OSA.1 Randomisation of patients with this phenotype to no treatment has been considered unethical. Thus, the long-term RCTs during the last decade have been …