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| Pàgina inicial > Articles > Articles publicats > Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea : |
(University Hospital Arnau de Vilanova and Santa María) (Brigham and Women's Hospital (Boston, Estats Units d'Amèrica)) (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Hospital Universitario de Cruces (Barakaldo, País Basc)) (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya)) (Complejo Hospitalario Universitario de Albacete) (Institut de Recerca Biomèdica de Lleida) (University Hospital Arnau de Vilanova and Santa María) (Brigham and Women's Hospital (Boston, Estats Units d'Amèrica))| Data: | 2023 |
| Resum: | 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. |
| Ajuts: | Instituto de Salud Carlos III PI22/00636 Instituto de Salud Carlos III PI10/02763 Instituto de Salud Carlos III PI10/02745 Instituto de Salud Carlos III PI18/00449 |
| Drets: | Aquest 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.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Publicat a: | European respiratory journal, Vol. 62, Num. 6 (december 2023) , ISSN 1399-3003 |
