Effects of CPAP on Atherosclerotic Coronary Plaques in Patients with Sleep-Disordered Breathing: the ENTERPRISE Trial

BackgroundThe effects of continuous positive airway pressure (CPAP) treatment on coronary atheroma volume and vulnerability in patients with sleep-disordered breathing (SDB) coexisting with coronary artery disease are not well known. Thus, this study aimed to verify how CPAP treatment affects coronary plaques in patients with SDB who underwent percutaneous coronary intervention (PCI). MethodsAltogether, fifty-three patients with SDB who underwent elective PCI using near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) were randomly assigned to two groups based on CPAP use. This study evaluated the absolute changes in percentage atheroma volume (PAV) and total atheroma volume by IVUS, and the absolute changes in maximum lipid core burden index calculated for every 4-mm segment (maxLCBI4mm) using NIRS from baseline to 12 months, in addition to major adverse cardiac and cerebrovascular events (MACCE), and all-cause death. ResultsIn the final analysis, 23 patients were allocated to the CPAP group, and 24 patients were allocated to the non-CPAP group. Compared with the non-CPAP group, the CPAP group had a significantly higher absolute change in PAV (-1.90{+/-}2.63% vs. 0.82{+/-}4.67%, p=0.018) and TAV (-20{+/-}35 mm3 vs. -2{+/-}21 mm3, p=0.041), and lower incidence rate of MACCE, mainly driven by a decrease in target lesion or non-target lesion target vessel revascularization (4% vs. 25%, p=0.037). In addition, adequate CPAP treatment resulted in greater plaque regression of -2.48%. However, there was no significant difference for absolute change in maxLCBI4mm (0 [-32, 40] vs. 34 [-71, 163], p=0.306) between the both groups, and no all-cause death was observed. ConclusionsCPAP treatment for patients with SDB contributed to a decline in coronary plaque volume and prevention of revascularization risk but did not mitigate lipid-rich plaques. Especially, adequate CPAP treatment had a greater effect on coronary plaque regression. Clinical Trial RegistrationThe Ethics Committee of the Juntendo Clinical Research and Trial Center approved this study (reference number 18-021), and which was registered with the UMIN (UMIN ID: R000036293). https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036293 Clinical PerspectiveThe effects of continuous positive airway pressure (CPAP) treatment on coronary atheroma volume and vulnerability in patients with sleep-disordered breathing (SDB) coexisting with coronary artery disease remains unclear. This study revealed that CPAP treatment for patients with SDB who underwent percutaneous coronary intervention contributed to a decline in coronary plaque volume and the prevention of cardiovascular events, mainly driven by a decrease in target vessel revascularization. In particular, adequate CPAP treatment may have a greater effect on coronary plaque regression; thus, it is important to focus on CPAP treatment and subsequent treatment compliance considering coronary plaques and events. In addition, patients with acute coronary syndrome who have greater plaque volume and lipid-rich plaques than those with stable coronary artery disease may benefit from the effects of adding CPAP treatment to optimal medical therapy due to an anti-atherogenic potential effect of CPAP treatment, thus, the further investigations targeting acute coronary syndrome are necessary.