Continuous positive airway pressure therapy for patients with obstructive sleep apnea and coronary artery disease

Obstructive sleep apnea (OSA) and coronary artery disease (CAD) frequently coexist, forming a bidirectional pathophysiological loop that amplifies cardiovascular risk. Intermittent hypoxemia in OSA patients promotes endothelial dysfunction, systemic inflammation, oxidative stress, and sympathetic activation, thereby accelerating atherogenesis, whereas myocardial ischemia and ventricular dysfunction in CAD patients can further destabilize upper-airway patency and exacerbate OSA. Continuous positive airway pressure (CPAP) is the standard therapy for OSA and reliably restores sleep architecture; however, large randomized trials have reported inconsistent effects on major adverse cardiovascular events, particularly in patients with established CAD. This mini review synthesizes contemporary data on CPAP across diverse OSA-CAD clinical scenarios, delineates patient phenotypes most likely to achieve cardiovascular benefit and identifies contexts in which CPAP provides limited protection. On the basis of these findings, we propose pragmatic recommendations for patient selection, adherence monitoring and optimization of CPAP therapy and highlight key research priorities, including extended follow-up, adherence-enhancing strategies and multimodal interventions. Clarifying the circumstances under which CPAP is cardioprotective will enable more precise management of patients with OSA, with or without concomitant CAD.