HCPLive spoke with Harneet Walia, MD, a sleep medicine specialist at Baptist Health, on new research linking positive airway pressure (PAP) therapy to improved
“We know that PAP therapy not only improves the symptoms related to sleep apnea, such as impairment in sleep quality or impairment in quality of life, but it may also have beneficial effects [on] the blood pressure as well,” Walia told HCPLive. “This has been known even in the past, but our study reinforces these findings, particularly as it relates to the real-world setting.”
The study demonstrated that PAP therapy was associated with a reduction in hemoglobin A1c (HbA1c), as well as in systolic and diastolic blood pressure.1
“Every millimeter reduction in blood pressure is associated with improved cardiovascular outcomes,” Walia continued. “So even though the reduction was noted to be modest, which is 2 to 4 millimeters of mercury reduction, this still could have huge implications in terms of improvement in cardiovascular risk reduction.”
PAP therapy, used in patients with sleep apnea, has previously demonstrated benefit on cardiovascular outcomes. A study published in August and led by Ali Azarbarzin from Brigham and Women’s Hospital in Boston found that continuous positive airway pressure (CPAP) lowered the risk of heart attack, stroke, and death from cardiovascular disease by around 17% in patients with high-risk obstructive sleep apnea (OSA).2 This improvement was 31% better than the effect of treatment in patients without high-risk OSA; investigators cautioned that among these individuals, CPAP may increase the risk of serious cardiovascular events by 22%.
In this new study, Walia and colleagues aimed to investigate the relationship between PAP therapy and various cardiometabolic factors in patients with sleep apnea, including HbA1c, systolic and diastolic blood pressure, triglycerides, and body mass index (BMI).1 The team collected 1575 patients (median age: 65 years; range: 58 – 71) with cardiometabolic disease from a multicenter cardiometabolic registry from January 2019 to August 2023. Among the 447 patients with sleep apnea, comprising 65.4% of the sample, 447 (65.4%) participants reported routine PPAP use.
In an unadjusted logistic regression analysis, PAP use was associated with lower HbA1c (-0.31%; 95 % confidence interval [CI], -0.59 to -0.04, P =.025), though it was no longer associated when adjusted for demographic factors, cardiac comorbidities, medications, and medication adherence (-0.19%; 95 % CI -0.46 to 0.08, P =.165).
Moreover, in an analysis adjusted by demographic factors, cardiac comorbidities, medications, and medication adherence, PAP therapy was associated with a lower systemic blood pressure (-3.99 mmHg, 95% CI -7.18 to -0.8, P =.014) and a lower diastolic blood pressure (-2.52 mmHg, 95% CI -4.45 to -0.6, P =.010).
“We do need long-term randomized control trials to validate these findings,” Walia said. “There have been certain randomized control trials that [have] been done in the past, which have shown sort of inconclusive results. However, [they] have also been limited in the interpretability because of the duration of the treatment, and more importantly, because of the PAP adherence…was not found to be optimal in those studies. So the future studies should certainly focus on long-term duration and [homing] in on optimal PAP adherence for the most periods of time.”
Relevant disclosures for Walia include Eli Lilly and Company, Resmed Corp, JAZZ Pharmaceuticals, Boston Scientific Corporation, Itamar Medical, Harmony Biosciences, Lilly USA, Fisher & Paykel Healthcare, Novo Nordisk, and Merck Sharp & Dohme.
References
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Körfer D, Cardenas W, Davis L, et al. Impact of sleep apnea treatment on cardiometabolic parameters in a large national multicenter alliance registry. Am J Prev Cardiol. 2025;23:101062. Published 2025 Jul 22. doi:10.1016/j.ajpc.2025.101062
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Treatment for sleep apnoea is good for the heart in some patients but bad for others. Escardio.org. Published 2025. Accessed September 29, 2025. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Treatment-for-sleep-apnoea-is-good-for-the-heart-in-some-patients-but-bad-for-others#