CPAP therapy may improve HFpEF-like features in coronary artery disease with obstructive sleep apnea : A randomized controlled trial
(2026) In Sleep Medicine 146.- Abstract
Background Obstructive sleep apnea (OSA) frequently coexists with coronary artery disease (CAD) and may contribute to heart failure with preserved ejection fraction (HFpEF). Whether HFpEF-like features are reversible with continuous positive airway pressure (CPAP) therapy remains uncertain. Methods A total of 177 revascularized CAD patients with nonsleepy OSA (Epworth Sleepiness Scale score <10; apnea–hypopnea index [AHI] ≥15/h) from the RICCADSA cohort randomized to CPAP (n = 89) or no CPAP (n = 88) were included. HFpEF-like status was defined using a composite of five echocardiographic and biomarker criteria (≥2 positive). Multivariable logistic regression models were constructed to assess the association between CPAP therapy and... (More)
Background Obstructive sleep apnea (OSA) frequently coexists with coronary artery disease (CAD) and may contribute to heart failure with preserved ejection fraction (HFpEF). Whether HFpEF-like features are reversible with continuous positive airway pressure (CPAP) therapy remains uncertain. Methods A total of 177 revascularized CAD patients with nonsleepy OSA (Epworth Sleepiness Scale score <10; apnea–hypopnea index [AHI] ≥15/h) from the RICCADSA cohort randomized to CPAP (n = 89) or no CPAP (n = 88) were included. HFpEF-like status was defined using a composite of five echocardiographic and biomarker criteria (≥2 positive). Multivariable logistic regression models were constructed to assess the association between CPAP therapy and HFpEF improvement, adjusting for age, sex, body mass index, AHI, hypertension, diabetes, log-transformed NT-proBNP, and E/e′ ratio. Results HFpEF-like features were present in 126 patients (71.2%), with similar prevalence in the CPAP and no-CPAP groups (69.7% vs 72.7%). Among patients with HFpEF-like status at baseline, improvement at 12 month-follow-up occurred in 24 of 62 patients (38.7%) randomized to CPAP compared with 13 of 64 (20.3%) in the no-CPAP group ( p = 0.023). In multivariable analysis, CPAP remained independently associated with HFpEF improvement (OR 2.85, 95% CI 1.13–7.22; p = 0.027). Higher baseline NT-proBNP was inversely associated with improvement (OR 0.37; p = 0.002), whereas E/e′ was not independently predictive. Conclusions CPAP therapy is independently associated with improvement in HFpEF-like features in patients with CAD and OSA, particularly among those with lower myocardial stress. These findings support the presence of a potentially modifiable HFpEF phenotype responsive to treatment of sleep-disordered breathing. Trial registration ClinicalTrials.gov
(Less)
- author
- Pihtili, Aylin ; Glantz, Helena ; Thunström, Erik and Peker, Yüksel LU
- organization
- publishing date
- 2026-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Continuous positive airway pressure, Coronary artery disease, Heart failure with preserved ejection fraction like phenotype, Obstructive sleep apnea
- in
- Sleep Medicine
- volume
- 146
- article number
- 109069
- publisher
- Elsevier
- external identifiers
-
- scopus:105041070703
- pmid:42250441
- ISSN
- 1389-9457
- DOI
- 10.1016/j.sleep.2026.109069
- language
- English
- LU publication?
- yes
- id
- 417ec9fd-165c-4b68-a2ea-2af344ed5bb6
- date added to LUP
- 2026-08-25 13:08:18
- date last changed
- 2026-08-25 13:09:02
@article{417ec9fd-165c-4b68-a2ea-2af344ed5bb6,
abstract = {{<p>Background Obstructive sleep apnea (OSA) frequently coexists with coronary artery disease (CAD) and may contribute to heart failure with preserved ejection fraction (HFpEF). Whether HFpEF-like features are reversible with continuous positive airway pressure (CPAP) therapy remains uncertain. Methods A total of 177 revascularized CAD patients with nonsleepy OSA (Epworth Sleepiness Scale score <10; apnea–hypopnea index [AHI] ≥15/h) from the RICCADSA cohort randomized to CPAP (n = 89) or no CPAP (n = 88) were included. HFpEF-like status was defined using a composite of five echocardiographic and biomarker criteria (≥2 positive). Multivariable logistic regression models were constructed to assess the association between CPAP therapy and HFpEF improvement, adjusting for age, sex, body mass index, AHI, hypertension, diabetes, log-transformed NT-proBNP, and E/e′ ratio. Results HFpEF-like features were present in 126 patients (71.2%), with similar prevalence in the CPAP and no-CPAP groups (69.7% vs 72.7%). Among patients with HFpEF-like status at baseline, improvement at 12 month-follow-up occurred in 24 of 62 patients (38.7%) randomized to CPAP compared with 13 of 64 (20.3%) in the no-CPAP group ( p = 0.023). In multivariable analysis, CPAP remained independently associated with HFpEF improvement (OR 2.85, 95% CI 1.13–7.22; p = 0.027). Higher baseline NT-proBNP was inversely associated with improvement (OR 0.37; p = 0.002), whereas E/e′ was not independently predictive. Conclusions CPAP therapy is independently associated with improvement in HFpEF-like features in patients with CAD and OSA, particularly among those with lower myocardial stress. These findings support the presence of a potentially modifiable HFpEF phenotype responsive to treatment of sleep-disordered breathing. Trial registration ClinicalTrials.gov</p>}},
author = {{Pihtili, Aylin and Glantz, Helena and Thunström, Erik and Peker, Yüksel}},
issn = {{1389-9457}},
keywords = {{Continuous positive airway pressure; Coronary artery disease; Heart failure with preserved ejection fraction like phenotype; Obstructive sleep apnea}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Sleep Medicine}},
title = {{CPAP therapy may improve HFpEF-like features in coronary artery disease with obstructive sleep apnea : A randomized controlled trial}},
url = {{http://dx.doi.org/10.1016/j.sleep.2026.109069}},
doi = {{10.1016/j.sleep.2026.109069}},
volume = {{146}},
year = {{2026}},
}