Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: apost hocstudy of the ISAACC trial

医学 持续气道正压 析因分析 入射(几何) 超重 内科学 人口 随机对照试验 比例危险模型 肥胖 儿科 阻塞性睡眠呼吸暂停 物理 环境卫生 光学
作者
Lucía Pinilla,N. Esmaeili,Gonzalo Labarca,Miguel Ángel Martínez‐García,Gerard Torres,Esther Gràcia-Lavedán,Olga Mínguez,Dolores Martínez,Jorge Abad,María José Masdeu,Olga Mediano,Carmen Múñoz,Valentín Cabriada,Joaquín Durán‐Cantolla,M. Mayos,Ramón Coloma,Josep M. Montserrat,Mónica de la Peña,Wen-Hsin Hu,Ludovico Messineo,Mohammadreza Sehhati,Andrew Wellman,Susan Redline,Scott A. Sands,Ferrán Barbé,Manuel Sánchez‐de‐la‐Torre,Ali Azarbarzin
出处
期刊:The European respiratory journal [European Respiratory Society]
卷期号:62 (6): 2300828-2300828 被引量:23
标识
DOI:10.1183/13993003.00828-2023
摘要

Background Hypoxic burden (HB) has emerged as a strong predictor of cardiovascular risk in obstructive sleep apnoea (OSA). We aimed to assess the potential of HB to predict the cardiovascular benefit of treating OSA with continuous positive airway pressure (CPAP). Methods This was a post hoc analysis of the ISAACC trial ( ClinicalTrials.gov : NCT01335087 ) including non-sleepy patients with acute coronary syndrome (ACS) diagnosed with OSA (apnoea–hypopnoea index ≥15 events·h −1 ) by respiratory polygraphy. Patients were randomised to CPAP or usual care and followed for a minimum of 1 year. HB was calculated as the total area under all automatically identified desaturations divided by total sleep time. Patients were categorised as having high or low baseline HB according to the median value (73.1%min·h −1 ). Multivariable Cox regression models were used to assess whether the effect of CPAP on the incidence of cardiovascular outcomes was dependent on the baseline HB level. Results The population (362 patients assigned to CPAP and 365 patients assigned to usual care) was middle-aged (mean age 59.7 years), overweight/obese and mostly male (84.5%). A significant interaction was found between the treatment arm and the HB categories. In the high HB group, CPAP treatment was associated with a significant reduction in the incidence of cardiovascular events (HR 0.57, 95% CI 0.34–0.96). In the low HB group, CPAP-treated patients exhibited a trend toward a higher risk of cardiovascular outcomes than those receiving usual care (HR 1.33, 95% CI 0.79–2.25). The differential effect of the treatment depending on the baseline HB level followed a dose–response relationship. Conclusion In non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis.
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