Does treating sleep apnea prevent heart attack, stroke, or death? A randomized controlled trial of about 2,700 patients found it did not. A 2025 meta-analysis of more than a million patients found that CPAP did improve mortality, but IMA Senior Fellow in Otolaryngology and Sleep Medicine Dr. Mary Talley Bowden points out that it was paid for by ResMed. Her honest answer is that she doesn’t know.
In this clip from her IMA Academy lesson, she’s clear that CPAP improves quality of life for patients with significant sleep apnea. But for those with mild or low-moderate cases who can’t use the machine and feel like they’re going to die in their sleep, she calls the struggle a battle that doesn’t need to be fought. Her favorite treatment is a sleep backpack, because in about 90% of the sleep studies she reads, patients are much worse on their backs. Losing 10% of body weight, she adds, reduces sleep apnea by 25%.
The full 35-minute lesson covers obstructive sleep apnea (OSA) from diagnosis to treatment. Dr. Bowden explains how to identify it earlier, how to read the Apnea-Hypopnea Index, and how the condition affects cardiovascular and overall health. She then compares CPAP, surgery, and oral appliances, and brings in newer concepts like hypoxic burden and positional OSA so that care can be matched to the individual patient rather than the average.
