Hypoxic Burden to Guide CPAP Treatment Allocation in OSA: Findings from the ISAACC Trial

Lucia Pinilla; Neda Esmaeili; Gonzalo Labarca; Olga Mínguez; Dolores Martínez; Jorge Abad; Maria José Masdeu; Olga Mediano; Carmen Múñoz; Valentín Cabriada; Joaquín Duran-Cantolla; Mercè Mayos; Ramón Coloma; Josep Maria Montserrat; Mónica de la Peña; Wen Hsin Hu; Andrew Wellman; Scott Sands; Ludovico Messineo; Ferran Barbé; Manuel Sánchez-de-la-Torre; Ali Azarbarzin

doi:10.1183/13993003.congress-2023.PA1274

Hypoxic Burden to Guide CPAP Treatment Allocation in OSA: Findings from the ISAACC Trial

Lucia Pinilla, Neda Esmaeili, Gonzalo Labarca, Olga Mínguez, Dolores Martínez, Jorge Abad, Maria José Masdeu, Olga Mediano, Carmen Múñoz, Valentín Cabriada, Joaquín Duran-Cantolla, Mercè Mayos, Ramón Coloma, Josep Maria Montserrat, Mónica de la Peña, Wen Hsin Hu, Andrew Wellman, Scott Sands, Ludovico Messineo, Ferran BarbéManuel Sánchez-de-la-Torre, Ali Azarbarzin

College of Medicine and Public Health

Research output: Contribution to journal › Meeting Abstract › peer-review

Abstract

Background: Hypoxic burden (HB) has emerged as a strong indicator of cardiovascular risk in OSA. Whether this metric could be useful to guide therapeutic decision making is unknown.

Aim: To assess the potential of baseline HB to predict cardiovascular benefit of CPAP therapy in non-sleepy OSA patients.

Methods: Post-hoc analysis of the ISAACC trial (NCT01335087) including non-sleepy subjects with acute coronary syndrome who underwent respiratory polygraphy (RP). OSA patients (AHI ≥15) were randomized to receive CPAP or usual care and were followed for a median of 3.35 years. HB was calculated for all OSA patients with available RP data, as total area under all automatically-identified desaturations divided by total sleep time [Esmaeili et al. ATS 2023 conference abstract]. Patients were categorized according to treatment allocation and the median value of HB (72.9 %min/h).

Results: A significant interaction was found between CPAP treatment and the HB groups [interaction HR (95% CI) = 0.46 (0.22-0.97)], after adjustment for confounders. CPAP therapy was associated with a significant long-term protection against cardiovascular events only in patients with high HB (Figure 1), with an adjusted risk reduction of 39% compared to usual care.

Conclusion: High HB was associated with a protective effect of CPAP on cardiovascular prognosis. This metric could be useful to identify non-sleepy OSA patients most likely to benefit from CPAP treatment.

Original language	English
Article number	PA1274
Number of pages	2
Journal	European Respiratory Journal
Volume	62
Issue number	Supplement 67
DOIs	https://doi.org/10.1183/13993003.congress-2023.PA1274
Publication status	Published - 9 Sept 2023
Event	ERS International Congress 2023 - Milan, Italy Duration: 9 Sept 2023 → 13 Sept 2023 https://www.ersnet.org/congress-and-events/congress/

Keywords

Obstructive sleep apnoea
Hypoxic burden
CPAP
Continuous positive airway pressure treatment

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Pinilla, L., Esmaeili, N., Labarca, G., Mínguez, O., Martínez, D., Abad, J., Masdeu, M. J., Mediano, O., Múñoz, C., Cabriada, V., Duran-Cantolla, J., Mayos, M., Coloma, R., Montserrat, J. M., de la Peña, M., Hu, W. H., Wellman, A., Sands, S., Messineo, L., ... Azarbarzin, A. (2023). Hypoxic Burden to Guide CPAP Treatment Allocation in OSA: Findings from the ISAACC Trial. European Respiratory Journal, 62(Supplement 67), Article PA1274. https://doi.org/10.1183/13993003.congress-2023.PA1274

@article{995c92d78fc8482795c223a9285d5f50,

title = "Hypoxic Burden to Guide CPAP Treatment Allocation in OSA: Findings from the ISAACC Trial",

abstract = "Background: Hypoxic burden (HB) has emerged as a strong indicator of cardiovascular risk in OSA. Whether this metric could be useful to guide therapeutic decision making is unknown.Aim: To assess the potential of baseline HB to predict cardiovascular benefit of CPAP therapy in non-sleepy OSA patients.Methods: Post-hoc analysis of the ISAACC trial (NCT01335087) including non-sleepy subjects with acute coronary syndrome who underwent respiratory polygraphy (RP). OSA patients (AHI ≥15) were randomized to receive CPAP or usual care and were followed for a median of 3.35 years. HB was calculated for all OSA patients with available RP data, as total area under all automatically-identified desaturations divided by total sleep time [Esmaeili et al. ATS 2023 conference abstract]. Patients were categorized according to treatment allocation and the median value of HB (72.9 %min/h).Results: A significant interaction was found between CPAP treatment and the HB groups [interaction HR (95% CI) = 0.46 (0.22-0.97)], after adjustment for confounders. CPAP therapy was associated with a significant long-term protection against cardiovascular events only in patients with high HB (Figure 1), with an adjusted risk reduction of 39% compared to usual care.Conclusion: High HB was associated with a protective effect of CPAP on cardiovascular prognosis. This metric could be useful to identify non-sleepy OSA patients most likely to benefit from CPAP treatment.",

keywords = "Obstructive sleep apnoea, Hypoxic burden, CPAP, Continuous positive airway pressure treatment",

author = "Lucia Pinilla and Neda Esmaeili and Gonzalo Labarca and Olga M{\'i}nguez and Dolores Mart{\'i}nez and Jorge Abad and Masdeu, {Maria Jos{\'e}} and Olga Mediano and Carmen M{\'u}{\~n}oz and Valent{\'i}n Cabriada and Joaqu{\'i}n Duran-Cantolla and Merc{\`e} Mayos and Ram{\'o}n Coloma and Montserrat, {Josep Maria} and {de la Pe{\~n}a}, M{\'o}nica and Hu, {Wen Hsin} and Andrew Wellman and Scott Sands and Ludovico Messineo and Ferran Barb{\'e} and Manuel S{\'a}nchez-de-la-Torre and Ali Azarbarzin",

year = "2023",

month = sep,

day = "9",

doi = "10.1183/13993003.congress-2023.PA1274",

language = "English",

volume = "62",

journal = "European Respiratory Journal",

issn = "1399-3003",

publisher = "European Respiratory Society",

number = "Supplement 67",

note = "ERS International Congress 2023 ; Conference date: 09-09-2023 Through 13-09-2023",

url = "https://www.ersnet.org/congress-and-events/congress/",

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Pinilla, L, Esmaeili, N, Labarca, G, Mínguez, O, Martínez, D, Abad, J, Masdeu, MJ, Mediano, O, Múñoz, C, Cabriada, V, Duran-Cantolla, J, Mayos, M, Coloma, R, Montserrat, JM, de la Peña, M, Hu, WH, Wellman, A, Sands, S, Messineo, L, Barbé, F, Sánchez-de-la-Torre, M & Azarbarzin, A 2023, 'Hypoxic Burden to Guide CPAP Treatment Allocation in OSA: Findings from the ISAACC Trial', European Respiratory Journal, vol. 62, no. Supplement 67, PA1274. https://doi.org/10.1183/13993003.congress-2023.PA1274

TY - JOUR

T1 - Hypoxic Burden to Guide CPAP Treatment Allocation in OSA

T2 - ERS International Congress 2023

AU - Pinilla, Lucia

AU - Esmaeili, Neda

AU - Labarca, Gonzalo

AU - Mínguez, Olga

AU - Martínez, Dolores

AU - Abad, Jorge

AU - Masdeu, Maria José

AU - Mediano, Olga

AU - Múñoz, Carmen

AU - Cabriada, Valentín

AU - Duran-Cantolla, Joaquín

AU - Mayos, Mercè

AU - Coloma, Ramón

AU - Montserrat, Josep Maria

AU - de la Peña, Mónica

AU - Hu, Wen Hsin

AU - Wellman, Andrew

AU - Sands, Scott

AU - Messineo, Ludovico

AU - Barbé, Ferran

AU - Sánchez-de-la-Torre, Manuel

AU - Azarbarzin, Ali

PY - 2023/9/9

Y1 - 2023/9/9

N2 - Background: Hypoxic burden (HB) has emerged as a strong indicator of cardiovascular risk in OSA. Whether this metric could be useful to guide therapeutic decision making is unknown.Aim: To assess the potential of baseline HB to predict cardiovascular benefit of CPAP therapy in non-sleepy OSA patients.Methods: Post-hoc analysis of the ISAACC trial (NCT01335087) including non-sleepy subjects with acute coronary syndrome who underwent respiratory polygraphy (RP). OSA patients (AHI ≥15) were randomized to receive CPAP or usual care and were followed for a median of 3.35 years. HB was calculated for all OSA patients with available RP data, as total area under all automatically-identified desaturations divided by total sleep time [Esmaeili et al. ATS 2023 conference abstract]. Patients were categorized according to treatment allocation and the median value of HB (72.9 %min/h).Results: A significant interaction was found between CPAP treatment and the HB groups [interaction HR (95% CI) = 0.46 (0.22-0.97)], after adjustment for confounders. CPAP therapy was associated with a significant long-term protection against cardiovascular events only in patients with high HB (Figure 1), with an adjusted risk reduction of 39% compared to usual care.Conclusion: High HB was associated with a protective effect of CPAP on cardiovascular prognosis. This metric could be useful to identify non-sleepy OSA patients most likely to benefit from CPAP treatment.

AB - Background: Hypoxic burden (HB) has emerged as a strong indicator of cardiovascular risk in OSA. Whether this metric could be useful to guide therapeutic decision making is unknown.Aim: To assess the potential of baseline HB to predict cardiovascular benefit of CPAP therapy in non-sleepy OSA patients.Methods: Post-hoc analysis of the ISAACC trial (NCT01335087) including non-sleepy subjects with acute coronary syndrome who underwent respiratory polygraphy (RP). OSA patients (AHI ≥15) were randomized to receive CPAP or usual care and were followed for a median of 3.35 years. HB was calculated for all OSA patients with available RP data, as total area under all automatically-identified desaturations divided by total sleep time [Esmaeili et al. ATS 2023 conference abstract]. Patients were categorized according to treatment allocation and the median value of HB (72.9 %min/h).Results: A significant interaction was found between CPAP treatment and the HB groups [interaction HR (95% CI) = 0.46 (0.22-0.97)], after adjustment for confounders. CPAP therapy was associated with a significant long-term protection against cardiovascular events only in patients with high HB (Figure 1), with an adjusted risk reduction of 39% compared to usual care.Conclusion: High HB was associated with a protective effect of CPAP on cardiovascular prognosis. This metric could be useful to identify non-sleepy OSA patients most likely to benefit from CPAP treatment.

KW - Obstructive sleep apnoea

KW - Hypoxic burden

KW - CPAP

KW - Continuous positive airway pressure treatment

U2 - 10.1183/13993003.congress-2023.PA1274

DO - 10.1183/13993003.congress-2023.PA1274

M3 - Meeting Abstract

SN - 1399-3003

VL - 62

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - Supplement 67

M1 - PA1274

Y2 - 9 September 2023 through 13 September 2023

ER -

Hypoxic Burden to Guide CPAP Treatment Allocation in OSA: Findings from the ISAACC Trial

Abstract

Keywords

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