Positive Airway Pressure Adherence, Mortality, and Cardiovascular Events in Patients with Sleep Apnea

医学 危险系数 气道正压 四分位数 内科学 阻塞性睡眠呼吸暂停 置信区间 比例危险模型 睡眠呼吸暂停 冲程(发动机) 随机对照试验 临床试验 机械工程 工程类
作者
Chloé Gervès-Pinquié,Sébastien Bailly,F. Goupil,Thierry Pigeanne,Sandrine Launois,Laurène Leclair‐Visonneau,Philippe Masson,Acya Bizieux-Thaminy,Margaux Blanchard,AbdelKébir Sabil,Dany Jaffuel,Jean-Louis Racineux,Wojciech Trzépizur,Frédéric Gagnadoux
出处
期刊:American Journal of Respiratory and Critical Care Medicine [American Thoracic Society]
卷期号:206 (11): 1393-1404 被引量:30
标识
DOI:10.1164/rccm.202202-0366oc
摘要

Rationale: Randomized controlled trials showed no effect of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on cardiovascular (CV) risk. However, patient selection and low PAP adherence preclude the generalization of their data to clinical samples. Objectives: To evaluate the association between hours of PAP use, mortality, and CV morbidity in real-life conditions. Methods: Data from the Pays de la Loire Cohort were linked to health administrative data to identify incident major adverse cardiovascular events (MACEs; a composite outcome of mortality, stroke, and cardiac diseases) in patients with OSA who were prescribed PAP. Cox proportional hazards analyses were conducted to evaluate the association between MACEs and quartiles of average daily PAP use over the study period. Measurements and Main Results: After a median follow-up of 6.6 years, 961 of 5,138 patients experienced MACEs. Considering nonadherent patients (0–4 h/night) as the reference group, adjusted hazard ratios (95% confidence intervals) for MACEs were 0.87 (0.73–1.04) for the 4–6 h/night group, 0.75 (0.62–0.92) for the 6–7 h/night group, and 0.78 (0.65–0.93) for the ⩾7 h/night group (P = 0.0130). Sensitivity analyses using causal inference approaches confirmed the association of PAP use with MACEs. The association was stronger in male patients (P value for interaction = 0.0004), patients without overt CV disease at diagnosis (P < 0.0001), and those belonging to the excessively sleepy symptom subtype (P = 0.060). Conclusions: These real-life clinical data demonstrate a dose–response relationship between PAP adherence and incident MACEs in OSA. Patient support programs may help improve PAP adherence and CV outcomes in patients with OSA.
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