Sleep Apnea (SA) is a recognized risk factor for hypertension, cardiovascular disease, and metabolic dysfunction. While clinical trials of positive airway pressure (PAP) therapy have shown mixed results, real-world registry data provide important insights into how this therapy may influence outcomes across diverse patient populations. A recent analysis from the Cardiometabolic Alliance Registry, led by researchers at Baptist Health Miami Cardiac & Vascular Institute, conducted between 2019 and 2023, examined these associations in patients with both SA and established cardiometabolic disease.
The study focused on 1575 patients who had been diagnosed with SA and also had conditions such as hypertension, type 2 diabetes, or obesity. Patients self-reported whether or not they used PAP therapy, and investigators compared cardiometabolic markers – including hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, and body mass index (BMI) – between users and non-users. Multivariable logistic regression models were applied, beginning with unadjusted analyses and progressing to models that accounted for demographic characteristics, comorbidities, and medication use.
The clearest and most consistent benefit was observed in blood pressure. PAP users showed significantly lower SBP and DBP compared with non-users. Even in the most fully adjusted model, PAP use was associated with an average SBP reduction of nearly 4 mmHg and a DBP reduction of about 2.5 mmHg. While modest in absolute terms, such reductions are considered clinically meaningful. As Harneet Kaur Walia, M.D., medical director of sleep medicine at Baptist Health Miami Cardiac & Vascular Institute, chief of clinical transformation for Baptist Health Medical Group, senior author of the study, explained: “We know from large epidemiologic studies that even small drops in blood pressure can translate into fewer strokes and heart attacks at the population level. Our findings suggest that PAP therapy may serve as a powerful tool in reducing blood pressure for patients with sleep apnea.”
The study also evaluated glucose control. PAP therapy appeared to lower HbA1c values in intermediate models, but the effect was no longer statistically significant after controlling for comorbidities, medication use, and adherence. This suggests that any potential benefit of PAP on glycemic control may be masked or confounded by these additional variables. Triglycerides and BMI were not significantly different between PAP users and non-users.
The registry’s large and diverse population strengthens the evidence base, although reliance on self-reported PAP use remains a limitation. Furthermore, the lack of objective adherence metrics prevents firm conclusions about dose-response effects.
Despite these limitations, the findings support the broader role of PAP as a cardiovascular risk–modifying therapy. “Sleep apnea treatment is often viewed only through the lens of symptom relief, but this study underscores its potential to change the trajectory of long-term heart health,” added Dr. Walia. “For patients with SA and cardiometabolic disease, PAP therapy should be considered part of comprehensive risk management, not just a tool for better sleep.”
In summary, this registry-based analysis demonstrates that PAP therapy is independently associated with reductions in systolic and diastolic blood pressure in patients with SA and cardiometabolic comorbidities. While improvements in glycemic control were not robust after adjustment, the consistent blood pressure benefits highlight PAP’s importance in cardiovascular prevention strategies. Future studies with prospective design, objective adherence data, and stratification by baseline cardiometabolic status will help clarify the extent of PAP’s protective role.
