Cardiovascular Benefit of Continuous Positive Airway Pressure in Adults with Coronary Artery Disease and Obstructive Sleep Apnea without Excessive Sleepiness

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Cardiovascular Benefit of Continuous Positive Airway Pressure in Adults with Coronary Artery Disease and Obstructive Sleep Apnea without Excessive Sleepiness

Azarbarzin, A. (author): Brigham and Women's Hospital / Harvard Medical School

Zinchuk, A. (author): Yale University

Wellman, A. (author): Brigham and Women's Hospital / Harvard Medical School

Labarca, G. (author): Brigham and Women's Hospital / Harvard Medical School

Vena, D. (author): Brigham and Women's Hospital / Harvard Medical School

Gell, L. (author): Brigham and Women's Hospital / Harvard Medical School

Messineo, L. (author): Flinders University,Brigham and Women's Hospital / Harvard Medical School

White, D. P. (author): Brigham and Women's Hospital / Harvard Medical School

Gottlieb, D. J. (author): Boston Veteran's Administration (VA) Healthcare,Brigham and Women's Hospital / Harvard Medical School

Redline, S. (author): Brigham and Women's Hospital / Harvard Medical School

Peker, Yüksel, 1961 (author): Lund University,Lunds universitet,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,Lungmedicin, allergologi och palliativ medicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Respiratory Medicine, Allergology, and Palliative Medicine,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Brigham and Women's Hospital / Harvard Medical School,University of Pittsburgh,Sahlgrenska Academy

Sands, S. A. (author)

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2022
2022
English.
In: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 206:6, s. 767-774

Related links:: http://dx.doi.org/10...; show more...; https://gup.ub.gu.se...; https://doi.org/10.1...; https://lup.lub.lu.s...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Rationale: Randomized controlled trials of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) have not demonstrated protection against adverse cardiovascular outcomes. Recently, observational studies revealed that OSA-related cardiovascular risk is concentrated in patients with an elevated pulse rate response to respiratory events (Delta HR). Objectives: Here, in this post hoc analysis of a prospective clinical trial, we test the hypothesis that a greater pretreatment Delta HR is associated with greater CPAP-related protection against adverse cardiovascular outcomes. Methods: Delta HR was measured from baseline polysomnography of the RICCADSA (Randomized Intervention with CPAP in CAD and OSA) randomized controlled trial (patients with coronary artery disease [CAD] and OSA [apnea-hypopnea index >= 15 events/h] with Epworth Sleepiness Scale score, 10; n(CPAP):n(control) = 113:113; male, 85%; age, 66 +/- 8 [mean +/- SD] yr). The primary outcome was a composite of repeat revascularization, myocardial infarction, stroke, and cardiovascular mortality. Multivariable Cox regression assessed whether the effect of CPAP was moderated by Delta HR (treatmentby-Delta HR interaction). Measurements and Main Results: The CPAP-related reduction in risk increased progressively with increasing pretreatment Delta HR (interaction hazard ratio [95% confidence interval], 0.49 [0.27 to 0.90] per SD increase in Delta HR; P, 0.05). This means that in patients with a Delta HR of 1 SD above the mean (i.e., 10 beats/min), CPAP was estimated to reduce cardiovascular risk by 59% (6% to 82%) (P<0.05), but no significant risk reduction was estimated in patients with a mean Delta HR (6 beats/min; CPAP risk reduction, 16% [253% to 54%]; P= 0.6). Conclusions: The protective effect of CPAP in patients with CAD and OSA without excessive sleepiness was modified by the Delta HR. Specifically, patients with higher Delta HR exhibit greater cardiovascular benefit from CPAP therapy.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)

Keyword

heart rate response
sleepiness
sleep apnea
cardiovascular
clinical
trial
hypopnea
outcomes
arousal
events
General & Internal Medicine
Respiratory System
clinical trial

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ref (subject category)
art (subject category)

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By the author/editor: Azarbarzin, A.; Zinchuk, A.; Wellman, A.; Labarca, G.; Vena, D.; Gell, L.; show more...; Messineo, L.; White, D. P.; Gottlieb, D. J.; Redline, S.; Peker, Yüksel, 1 ...; Sands, S. A.; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Respiratory Medi ...

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By the university: University of Gothenburg; Lund University

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