Nearly half of clinical populations with coronary artery disease (CAD) also have obstructive sleep apnoea (OSA) and these individuals have worse prognosis compared with CAD patients without OSA. Moreover, despite advances in medical treatment and revascularisation techniques, many CAD patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) experience major adverse cardiac and cerebrovascular events (MACCEs) in the years following the intervention. It has been suggested that OSA may contribute to the occurrence of MACCEs in
revascularised CAD cohorts. In a 6-month follow-up study after PCI, MACCEs were observed in almost 24% of patients with concomitant OSA compared with 5% of those without OSA. More recent data support an independent relationship between OSA and subsequent MACCEs in patients undergoing PCI, as well as in those treated with CABG.
Continuous positive airway pressure (CPAP) is recommended as first-line treatment for OSA, and is associated with reduced daytime sleepiness and improved quality of life in symptomatic patients. However, the majority of CAD patients with OSA do not experience daytime sleepiness and there is currently no clearly established rationale for treatment in such patients. CPAP has been shown to be beneficial in patients with CAD and OSA who are adherent to treatment. An observational, non-randomised study suggested that patients who received CPAP treatment for OSA had reduced cardiac
mortality at 5 years after PCI compared with those who declined CPAP treatment. Until recently,there was a lack of long-term prospective randomised controlled trials (RCTs) to address whether cardiac patients with non sleepy OSA should be offered CPAP treatment to reduce MACCEs.
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