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What Causes What
MECHANISM0 NULL

Obstructive sleep apnea → Major cardiovascular events

A rise in Obstructive sleep apnea does not identify a change in Major cardiovascular events.

McEvoy 2016 found that CPAP plus usual care did not change the risk of a composite cardiovascular event versus usual care alone among 2717 adults with moderate-to-severe obstructive sleep apnea and established coronary or cerebrovascular disease (hazard ratio 1.10, 95% CI 0.91 to 1.32).

Randomized trial · Moderate · N=2717

Supported by an experiment or a tightly identified design. Read the caveats.

Mechanism

McEvoy, Antic, Heeley and colleagues assigned 2717 adults aged 45 to 75 with moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to CPAP plus usual care or usual care alone, after a one-week sham-CPAP run-in (SAVE, NCT00738179). Most were men with minimal sleepiness. Mean CPAP use was 3.3 hours a night. The apnea-hypopnea index fell from 29.0 to 3.7 events an hour. After a mean 3.7 years, a primary event (cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or TIA) occurred in 229 people on CPAP (17.0%) and 207 on usual care (15.4%). The hazard ratio was 1.10 (0.91 to 1.32, P=0.34). No single cardiovascular end point moved. Snoring, sleepiness, quality of life, and mood improved. Those are not the primary. Peker, Glantz, Eulenburg and colleagues assigned 244 people with newly revascularized coronary disease and nonsleepy OSA (AHI at least 15, Epworth under 10) to auto-titrating CPAP or no PAP (RICCADSA, NCT00519597). Median follow-up was 57 months. The composite of repeat revascularization, myocardial infarction, stroke, or cardiovascular death was 18.1% versus 22.1% (hazard ratio 0.80, 0.46 to 1.41, P=0.449). An on-treatment cut at four hours a night is not the assigned contrast. Sánchez-de-la-Torre and colleagues assigned 1264 nonsleepy patients with acute coronary syndrome and OSA at 15 Spanish hospitals to CPAP plus usual care or usual care alone, 633 versus 631 (ISAACC, NCT01335087). Median follow-up was 3.35 years. A composite cardiovascular event occurred in 98 people on CPAP (16%) and 108 on usual care (17%). The hazard ratio was 0.89 (0.68 to 1.17, P=0.40). Mean CPAP use was 2.78 hours a night. A reference group without OSA did not fare differently from usual-care OSA. The signed object is obstruction. A machine that holds the airway open is less OSA. When that assignment does not move the event count, more apnea does not identify more events in these samples.

Caveats

SAVE is secondary prevention in people who already have coronary or cerebrovascular disease. Participants had minimal sleepiness. Mean use was 3.3 hours a night. The machine is open-label. The abstract names 2,717 people. Evidence grade is RICCADSA is one center, 244 people, nonsleepy by Epworth. The intention-to-treat result is null. The paper's adjusted on-treatment analysis (four hours or more) is not the assigned contrast and does not set the sign. ISAACC is acute coronary syndrome, nonsleepy, Spain, open-label. Mean use was 2.78 hours a night. The abstract we have is cut before the primary count. The numbers above are from the published abstract. Blood pressure and Epworth shifts in ISAACC are not this page. Ou 2024 compared a mandibular advancement device with CPAP on 24-hour mean arterial pressure. That is blood pressure, not an event composite. It is not on this page. This page does not add a blood-pressure claim. This page is not HOMA-IR. That pair is the apnea-and-insulin page. It is not all-cause death. It is not a reason to start or stop a machine. More papers of the same design do not settle the claim. This is a journal entry, not medical advice.

Effect

odds_ratio = 1.1. McEvoy 2016 SAVE: HR 1.10 (0.91-1.32), 229 vs 207 events, N=2717. Peker RICCADSA ITT HR 0.80 (0.46-1.41). Sánchez-de-la-Torre ISAACC HR 0.89 (0.68-1.17).

Nodes

Biology & endocrinologyObstructive sleep apneaBiology & endocrinologyMajor cardiovascular events

Named confounders

Cite this page

What Causes What. “Obstructive sleep apnea → Major cardiovascular events.” https://whatcauseswhat.org/edges/e-osa-cv (atlas updated 2026-09-02).

https://whatcauseswhat.org/edges/e-osa-cv

Papers