Continuous Positive Airway Pressure Therapy and Cardiovascular Outcomes in Adults with Obstructive Sleep Apnea: A Cohort Study Using the TriNetX Database.

Abstract

Background: Obstructive sleep apnea (OSA) is a common sleep disorder associated with increased cardiovascular morbidity. Continuous positive airway pressure (CPAP) therapy is the standard treatment; however, its long-term cardiovascular benefits remain uncertain. Aim: To evaluate 5-year associations between CPAP therapy and the risks of cardiovascular diseases in patients with OSA. Methods: This retrospective cohort study used the TriNetX global database, including adults diagnosed with OSA between 2014 and 2025. Patients with prior cardiovascular disease were excluded. After 1:1 propensity score matching, 54,635 CPAP users were compared to matched nonusers. Participants were followed from 1 day to 5 years after the index date. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for incident cardiovascular outcomes. Sensitivity analyses were performed at 1- and 3-month follow-up thresholds. Results: CPAP therapy was associated with significantly lower risks of stroke (HR 0.861), transient ischemic attack (HR 0.699), atrial fibrillation/flutter (HR 0.781), bradycardia (HR 0.899), ventricular arrhythmias (HR 0.875), pericarditis (HR 0.768), angina (HR 0.619), major adverse cardiovascular events (HR 0.936), and cardiac conduction and functional disorders (HR 0.861). No significant risk reduction was observed for pulmonary embolisms, deep vein thromboses, myocardial infarction, or structural cardiac abnormalities. Sensitivity analyses confirmed the robustness of most findings. Conclusions: In patients with OSA, CPAP therapy was associated with reduced risks of several cardiovascular outcomes over 5 years, although benefits were not observed across all conditions. These findings highlight the potential but selective cardiovascular benefits of CPAP therapy, warranting further prospective and randomized studies.