Sleep Medicine

Causal survival forests reveal striking heterogeneity in CPAP’s cardiovascular effects in non-sleepy OSA

This re-analysis of SAVE (n = 2,687) used causal survival forests to estimate individualized cardiovascular treatment effects of CPAP in non-sleepy OSA. Marked heterogeneity emerged, with a high area under the target operator characteristic curve indicating strong separation of responders and non-responders. Patients in the tertile predicted to benefit had dramatically better event-free survival when randomized to CPAP. Those predicted to be harmed had markedly higher major adverse cardiovascular events on CPAP compared with control. These findings challenge uniform CPAP prescription for cardiovascular prevention and support phenotype-based, precision use in non-sleepy OSA. 1

Early home follow-up visit boosts CPAP adherence in initially low and intermediate users

This multicenter cohort of 4,924 new CPAP users evaluated an early home visit about 16 days after initiation. Overall, adherence increased by 14 minutes per night in the week after versus before the visit. Intermediate and low early adherers gained roughly 60 and 102 minutes per night, respectively, while high adherers slightly declined. Cluster analysis revealed responder and non-responder trajectories, partially predicted by age, motivation, leak, and residual AHI. These data support structured early follow-up, especially for initially low or intermediate users, to improve CPAP usage. 2

High hypoxic burden or heart rate response in OSA predicts higher incident AF in MESA

This MESA analysis classified OSA patients with AHI ≥15/h as high cardiovascular risk when hypoxic burden or heart rate response were in the highest tertile. Among 1,679 participants followed a median 6.7 years, AF incidence was highest in high-risk OSA and lowest in non-OSA. Compared with non-OSA, high-risk OSA had significantly increased AF risk (HR 1.68; 95% CI 1.17–2.41), unlike low-risk OSA. Associations were similar in women and men, suggesting sex-independent risk stratification. Event-related hypoxemia and autonomic surges may better guide AF risk counseling than AHI alone. 3