Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a Post-hoc study of the ISAACC trial.
Por:
Pinilla L, Esmaeili N, Labarca G, Martinez-Garcia MÁ, Torres G, Gracia-Lavedan E, Mínguez O, Martínez D, Abad J, José Masdeu M, Mediano O, Muñoz C, Cabriada V, Duran-Cantolla J, Mayos M, Coloma R, Montserrat JM, de la Peña M, Hu WH, Messineo L, MohammadReza S, Wellman A, Redline S, Sands S, Barbé F, Sánchez-de-la-Torre M, Azarbarzin A
Publicada:
7 dic 2023
Ahead of Print:
21 sep 2023
Resumen:
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).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 to Usual Care) was middle-aged, overweight/obese, and mostly males. 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 (95% CI)=0.57 (0.34 to 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 (95% CI)=1.33 (0.79 to 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.
Filiaciones:
Pinilla L:
Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Co-first authors
Esmaeili N:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Bioelectric and Biomedical Engineering department, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Co-first authors
Labarca G:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Martinez-Garcia MÁ:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Pneumology department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Torres G:
Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Gracia-Lavedan E:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Mínguez O:
Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Martínez D:
Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Abad J:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Pneumology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
José Masdeu M:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Pneumology Department, University Hospital Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
Mediano O:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Pneumology Department, University Hospital of Guadalajara, Guadalajara, Spain
Muñoz C:
Pneumology Department, University Hospital of Burgos, Burgos, Spain
Cabriada V:
Pneumology Department, University Hospital of Cruces, Bizkaia, Spain
Duran-Cantolla J:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Bioaraba Health Research Institute, University Hospital of Araba, Vitoria, Spain
Mayos M:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Sleep Unit, Pneumology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
Coloma R:
Pneumology Department, University Hospital of Albacete, Albacete, Spain
Montserrat JM:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Pneumology Department, Clinic Hospital, Barcelona, Spain
de la Peña M:
University Hospital Son Espases, Research Institute of Palma, Palma de Mallorca, Spain
Hu WH:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Messineo L:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
MohammadReza S:
Bioelectric and Biomedical Engineering department, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Wellman A:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Redline S:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Sands S:
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Barbé F:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Sánchez-de-la-Torre M:
Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María
University of Lleida
IRBLleida, Lleida, Spain
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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