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- Azarbarzin, A., et al.
(författare)
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Cardiovascular Benefit of Continuous Positive Airway Pressure in Adults with Coronary Artery Disease and Obstructive Sleep Apnea without Excessive Sleepiness
- 2022
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 206:6, s. 767-774
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Redline, S., et al.
(författare)
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Obstructive sleep apnoea heterogeneity and cardiovascular disease
- 2023
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Ingår i: Nature Reviews Cardiology. - : Springer Science and Business Media LLC. - 1759-5002 .- 1759-5010. ; 20, s. 560-573
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Forskningsöversikt (refereegranskat)abstract
- In this Review, Redline and colleagues summarize our understanding of the shared risk factors and causal links between obstructive sleep apnoea (OSA) and cardiovascular disease and emerging knowledge on the heterogeneity of OSA. They also explore the potential role of new biomarkers for cardiovascular risk stratification in patients with OSA. Obstructive sleep apnoea (OSA), characterized by recurrent periods of upper airway obstruction and intermittent hypoxaemia, is prevalent in patients with cardiovascular disease (CVD), and is therefore important to consider in the prevention and management of CVD. Observational studies indicate that OSA is a risk factor for incident hypertension, poorly controlled blood pressure, stroke, myocardial infarction, heart failure, cardiac arrhythmias, sudden cardiac death and all-cause death. However, clinical trials have not provided consistent evidence that treatment with continuous positive airway pressure (CPAP) improves cardiovascular outcomes. These overall null findings might be explained by limitations in trial design and low levels of adherence to CPAP. Studies have also been limited by the failure to consider OSA as a heterogeneous disorder that consists of multiple subtypes resulting from variable contributions from anatomical, physiological, inflammatory and obesity-related risk factors, and resulting in different physiological disturbances. Novel markers of sleep apnoea-associated hypoxic burden and cardiac autonomic response have emerged as predictors of OSA-related susceptibility to adverse health outcomes and treatment response. In this Review, we summarize our understanding of the shared risk factors and causal links between OSA and CVD and emerging knowledge on the heterogeneity of OSA. We discuss the varied mechanistic pathways that result in CVD that also vary across subgroups of OSA, as well as the potential role of new biomarkers for CVD risk stratification.
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