Comparison of Findings: SAVE, RICCADSA, and ISAACC Trials

AspectSAVE TrialRICCADSA TrialISAACC Trial
Population StudiedOSA patients with established cardiovascular disease (CVD).Coronary artery disease (CAD) patients with nonsleepy OSA.Acute coronary syndrome (ACS) patients with OSA.
Primary ObjectiveAssess whether CPAP reduces cardiovascular events in patients with OSA and CVD.Evaluate the effect of CPAP on cardiovascular outcomes in CAD patients with nonsleepy OSA.Investigate the impact of CPAP on cardiovascular events in ACS patients with OSA.
Primary FindingsCPAP did not significantly reduce major cardiovascular events (hazard ratio [HR]: 1.10, p = 0.34).CPAP did not significantly reduce cardiovascular outcomes in intention-to-treat analyses but improved depression scores.CPAP did not significantly reduce cardiovascular events but showed benefits in patients with high hypoxic burden.
Cardiovascular MortalityNo significant reduction in cardiovascular death with CPAP.No significant effect on cardiovascular mortality in nonsleepy OSA patients.CPAP may reduce cardiovascular mortality in patients with high hypoxic burden.
Depression SymptomsCPAP improved depression symptoms, especially in patients with pre-existing depressive symptoms.CPAP significantly improved depressive symptoms over 3 and 12 months.Depression outcomes not specifically assessed.
Quality of Life (QoL)CPAP improved QoL in terms of sleep-related symptoms but had no impact on cardiovascular outcomes.CPAP had mixed effects on health-related QoL, with improvements in mental health domains.QoL changes were not the primary focus of the study.
Hypoxic BurdenNo direct focus on hypoxic burden, though its role was acknowledged in post hoc analyses.Hypoxic burden not a primary outcome but indirectly linked to CPAP benefits in secondary analyses.High hypoxic burden predicted greater benefit from CPAP in reducing cardiovascular events.
Adherence ImpactAdherence to CPAP (>4 hours/night) showed symptom improvements but no clear cardiovascular benefits.Adherent patients showed improved outcomes, especially in depression.Adherence to CPAP in patients with high hypoxic burden showed reduced cardiovascular risk.
Comorbid ConditionsFocused on patients with OSA and cardiovascular comorbidities.Included CAD patients with nonsleepy OSA; less focus on other comorbidities.Targeted ACS patients with OSA, emphasizing cardiovascular outcomes.
ConclusionCPAP improves symptoms (e.g., sleepiness, depression) but does not prevent major cardiovascular events.CPAP provides symptom relief (e.g., depression) but does not significantly alter cardiovascular outcomes.CPAP does not reduce cardiovascular events universally but benefits patients with high hypoxic burden.

Summary

  • SAVE Trial: Focused on established CVD patients and found no cardiovascular benefit of CPAP despite symptom improvements.
  • RICCADSA Trial: Highlighted CPAP’s role in improving depression and QoL in CAD patients with nonsleepy OSA but no cardiovascular event reduction.
  • ISAACC Trial: Showed that CPAP benefits patients with high hypoxic burden in reducing cardiovascular events, but not in the overall population.