Adherence
Positive Airway Pressure (PAP) therapy, while effective for reducing AHI and improving symptoms, has not demonstrated a benefit on composite cardiovascular endpoints in randomized controlled trials.
PAP is the standard treatment for OSA and effectively reduces breathing interruptions and daytime sleepiness. However, it does not appear to reduce long-term cardiovascular risks like heart attacks or strokes in large studies, and many patients struggle with adherence due to discomfort. It remains a good option for symptomatic relief and blood pressure control, but may not be a 'one-size-fits-all' solution.
PAP has not demonstrated a benefit on composite cardiovascular endpoints in randomized controlled trials for primary [23] or secondary cardiovascular prevention [24–26]. For example, in the largest randomized trial to date (Sleep Apnea Cardiovascular Endpoints, SAVE), there was no difference in the incidence of strokes, heart attacks, composite cardiovascular mortality, or other cardiovascular endpoints between the PAP and usual‑care groups [24].
Why this rating
Based on large RCTs like SAVE and meta-analyses.
Source
Obstructive Sleep Apnea: An Evolving Therapeutic Landscape with an Emerging Role for Incretin-Based Therapies
Bugao Xu et al. · Advances in Therapy · 2025
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