TY - JOUR
T1 - Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea
T2 - a post hoc study of the ISAACC trial
AU - Pinilla, Lucía
AU - Esmaeili, Neda
AU - Labarca, Gonzalo
AU - Martinez-Garcia, Miguel Ángel
AU - Torres, Gerard
AU - Gracia-Lavedan, Esther
AU - Mínguez, Olga
AU - Martínez, Dolores
AU - Abad, Jorge
AU - Masdeu, Maria José
AU - Mediano, Olga
AU - Muñoz, Carmen
AU - Cabriada, Valentín
AU - Duran-Cantolla, Joaquín
AU - Mayos, Mercè
AU - Coloma, Ramón
AU - Montserrat, Josep María
AU - la Peña, Mónica de
AU - Hu, Wen Hsin
AU - Messineo, Ludovico
AU - Sehhati, Mohammadreza
AU - Wellman, Andrew
AU - Redline, Susan
AU - Sands, Scott
AU - Barbé, Ferran
AU - Sánchez-De-la-Torre, Manuel
AU - Azarbarzin, Ali
PY - 2023/12/1
Y1 - 2023/12/1
N2 - 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·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. 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. ConclusionIn non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis.
AB - 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·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. 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. ConclusionIn non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis.
KW - Obstructive sleep apnoea
KW - Hypoxic burden
KW - CPAP
KW - Continuous positive airway pressure treatment
UR - http://www.scopus.com/inward/record.url?scp=85180011486&partnerID=8YFLogxK
U2 - 10.1183/13993003.00828-2023
DO - 10.1183/13993003.00828-2023
M3 - Article
C2 - 37734857
AN - SCOPUS:85180011486
SN - 0903-1936
VL - 62
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 6
M1 - 2300828
ER -