Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a study of the ISAACC trial
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 analysi...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Formato: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2023 |
| País: | España |
| Recursos: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p4293 |
| Acesso em linha: | https://i3pt.portalinvestigacion.com/publicaciones/4293 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85180011486&doi=10.1183%2f13993003.00828-2023&partnerID=40&md5=a0dbd8e822cf625641c55c4e5aab91fb |
| Access Level: | acceso abierto |
| Palavra-chave: | Acute Coronary Syndrome Continuous Positive Airway Pressure Female Humans Hypoxia Male Middle Aged Proportional Hazards Models Sleep Apnea, Obstructive acute coronary syndrome adult age aged apnea hypopnea index Article cohort analysis continuous positive airway pressure controlled study disease burden female follow up high risk patient human hypoxia hypoxic burden incidence low risk patient major clinical study male obesity obstructive sleep apnea outcomes research oxygen desaturation polysomnography post hoc analysis prediction prognosis proportional hazards model sex sleep time trend study complication middle aged randomized controlled trial sleep apnea syndromes |
| Resumo: | 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 center dot 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 center dot 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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