Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea
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). This was a post hoc analysis of the ISAACC tri...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:290175 |
| Acceso en línea: | https://ddd.uab.cat/record/290175 https://dx.doi.org/urn:doi:10.1183/13993003.00828-2023 |
| Access Level: | acceso abierto |
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Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoeaa post hoc study of the ISAACC trialPinilla, Lucía|||0000-0003-2825-4056Esmaeili, NedaLabarca, Gonzalo|||0000-0002-0069-3420Martínez García, Miguel Ángel|||0000-0002-7321-1891Torres, Gerard|||0000-0002-1417-7320Gracia-Lavedan, EstherMínguez, OlgaMartínez López, DoloresAbad Capa, Jorge|||0000-0002-8129-7859Masdeu, Maria JoséMediano, Olga|||0000-0001-7824-1523Muñoz-Batet, Carmen|||0000-0002-4150-8834Cabriada-Nuño, Valentín|||0000-0003-1124-7108Duran-Cantolla, Joaquin|||0000-0001-8172-9415Mayos, Merce|||0000-0003-3972-3671Coloma Navarro, Ramón|||0000-0002-4280-415XMontserrat, Josep MaríaDe la Peña, Mónica|||0000-0003-3276-776XHu, Wen-HsinMessineo, LudovicoSehhati, MohammadrezaWellman, AndrewRedline, SusanSands, ScottBarbé, Ferran|||0000-0002-2340-8928Sánchez de la Torre, Manuel|||0000-0002-5695-348XAzarbarzin, Ali|||0000-0002-4986-4753Hypoxic 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). This was a post hoc analysis of the ISAACC trial (: 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. 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. In non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis.Universitat Autònoma de Barcelona. Departament de Medicina 22023-01-0120232023-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/290175https://dx.doi.org/urn:doi:10.1183/13993003.00828-2023reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI22/00636Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI10/02763Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI10/02745Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI18/00449open accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2901752026-06-06T12:50:31Z |
| dc.title.none.fl_str_mv |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea a post hoc study of the ISAACC trial |
| title |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea |
| spellingShingle |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea Pinilla, Lucía|||0000-0003-2825-4056 |
| title_short |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea |
| title_full |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea |
| title_fullStr |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea |
| title_full_unstemmed |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea |
| title_sort |
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea |
| dc.creator.none.fl_str_mv |
Pinilla, Lucía|||0000-0003-2825-4056 Esmaeili, Neda Labarca, Gonzalo|||0000-0002-0069-3420 Martínez García, Miguel Ángel|||0000-0002-7321-1891 Torres, Gerard|||0000-0002-1417-7320 Gracia-Lavedan, Esther Mínguez, Olga Martínez López, Dolores Abad Capa, Jorge|||0000-0002-8129-7859 Masdeu, Maria José Mediano, Olga|||0000-0001-7824-1523 Muñoz-Batet, Carmen|||0000-0002-4150-8834 Cabriada-Nuño, Valentín|||0000-0003-1124-7108 Duran-Cantolla, Joaquin|||0000-0001-8172-9415 Mayos, Merce|||0000-0003-3972-3671 Coloma Navarro, Ramón|||0000-0002-4280-415X Montserrat, Josep María De la Peña, Mónica|||0000-0003-3276-776X Hu, Wen-Hsin Messineo, Ludovico Sehhati, Mohammadreza Wellman, Andrew Redline, Susan Sands, Scott Barbé, Ferran|||0000-0002-2340-8928 Sánchez de la Torre, Manuel|||0000-0002-5695-348X Azarbarzin, Ali|||0000-0002-4986-4753 |
| author |
Pinilla, Lucía|||0000-0003-2825-4056 |
| author_facet |
Pinilla, Lucía|||0000-0003-2825-4056 Esmaeili, Neda Labarca, Gonzalo|||0000-0002-0069-3420 Martínez García, Miguel Ángel|||0000-0002-7321-1891 Torres, Gerard|||0000-0002-1417-7320 Gracia-Lavedan, Esther Mínguez, Olga Martínez López, Dolores Abad Capa, Jorge|||0000-0002-8129-7859 Masdeu, Maria José Mediano, Olga|||0000-0001-7824-1523 Muñoz-Batet, Carmen|||0000-0002-4150-8834 Cabriada-Nuño, Valentín|||0000-0003-1124-7108 Duran-Cantolla, Joaquin|||0000-0001-8172-9415 Mayos, Merce|||0000-0003-3972-3671 Coloma Navarro, Ramón|||0000-0002-4280-415X Montserrat, Josep María De la Peña, Mónica|||0000-0003-3276-776X Hu, Wen-Hsin Messineo, Ludovico Sehhati, Mohammadreza Wellman, Andrew Redline, Susan Sands, Scott Barbé, Ferran|||0000-0002-2340-8928 Sánchez de la Torre, Manuel|||0000-0002-5695-348X Azarbarzin, Ali|||0000-0002-4986-4753 |
| author_role |
author |
| author2 |
Esmaeili, Neda Labarca, Gonzalo|||0000-0002-0069-3420 Martínez García, Miguel Ángel|||0000-0002-7321-1891 Torres, Gerard|||0000-0002-1417-7320 Gracia-Lavedan, Esther Mínguez, Olga Martínez López, Dolores Abad Capa, Jorge|||0000-0002-8129-7859 Masdeu, Maria José Mediano, Olga|||0000-0001-7824-1523 Muñoz-Batet, Carmen|||0000-0002-4150-8834 Cabriada-Nuño, Valentín|||0000-0003-1124-7108 Duran-Cantolla, Joaquin|||0000-0001-8172-9415 Mayos, Merce|||0000-0003-3972-3671 Coloma Navarro, Ramón|||0000-0002-4280-415X Montserrat, Josep María De la Peña, Mónica|||0000-0003-3276-776X Hu, Wen-Hsin Messineo, Ludovico Sehhati, Mohammadreza Wellman, Andrew Redline, Susan Sands, Scott Barbé, Ferran|||0000-0002-2340-8928 Sánchez de la Torre, Manuel|||0000-0002-5695-348X Azarbarzin, Ali|||0000-0002-4986-4753 |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Universitat Autònoma de Barcelona. Departament de Medicina |
| description |
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). This was a post hoc analysis of the ISAACC trial (: 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. 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. In non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis. |
| publishDate |
2023 |
| dc.date.none.fl_str_mv |
2 2023-01-01 2023 2023-01-01 |
| dc.type.none.fl_str_mv |
Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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info:eu-repo/semantics/article |
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article |
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https://ddd.uab.cat/record/290175 https://dx.doi.org/urn:doi:10.1183/13993003.00828-2023 |
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https://ddd.uab.cat/record/290175 https://dx.doi.org/urn:doi:10.1183/13993003.00828-2023 |
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Inglés eng |
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Inglés |
| language |
eng |
| dc.relation.none.fl_str_mv |
Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI22/00636 Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI10/02763 Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI10/02745 Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI18/00449 |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by-nc/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by-nc/4.0/ |
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openAccess |
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