Yüksel Peker1,2, Helena Glantz1,3, Christine Eulenburg4, Karl Wegscheider4, Johan Herlitz5,6, Erik Thunström1,7. 1. 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 2. 2 Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey. 3. 3 Department of Internal Medicine, Skaraborg Hospital, Skövde, Sweden. 4. 4 Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany. 5. 5 Center of Prehospital Care of Western Sweden, University College of Borås, Borås, Sweden. 6. 6 Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden; and. 7. 7 Department of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Abstract
RATIONALE: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), many of whom do not report daytime sleepiness. First-line treatment for symptomatic OSA is continuous positive airway pressure (CPAP), but its value in patients without daytime sleepiness is uncertain. OBJECTIVES: To determine the effects of CPAP on long-term adverse cardiovascular outcome risk in patients with CAD with nonsleepy OSA. METHODS: This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized CAD and OSA (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating CPAP (n = 122) or no positive airway pressure (n = 122). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive CPAP (18.1% vs. 22.1%; hazard ratio, 0.80; 95% confidence interval, 0.46-1.41; P = 0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used CPAP for ≥4 versus <4 hours per night or did not receive treatment (hazard ratio, 0.29; 95% confidence interval, 0.10-0.86; P = 0.026). CONCLUSIONS: Routine prescription of CPAP to patients with CAD with nonsleepy OSA did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 00519597).
RCT Entities:
RATIONALE: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), many of whom do not report daytime sleepiness. First-line treatment for symptomatic OSA is continuous positive airway pressure (CPAP), but its value in patients without daytime sleepiness is uncertain. OBJECTIVES: To determine the effects of CPAP on long-term adverse cardiovascular outcome risk in patients with CAD with nonsleepy OSA. METHODS: This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized CAD and OSA (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating CPAP (n = 122) or no positive airway pressure (n = 122). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive CPAP (18.1% vs. 22.1%; hazard ratio, 0.80; 95% confidence interval, 0.46-1.41; P = 0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used CPAP for ≥4 versus <4 hours per night or did not receive treatment (hazard ratio, 0.29; 95% confidence interval, 0.10-0.86; P = 0.026). CONCLUSIONS: Routine prescription of CPAP to patients with CAD with nonsleepy OSA did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 00519597).
Authors: Susheel P Patil; Indu A Ayappa; Sean M Caples; R Joh Kimoff; Sanjay R Patel; Christopher G Harrod Journal: J Clin Sleep Med Date: 2019-02-15 Impact factor: 4.062
Authors: Sairam Parthasarathy; Mary A Carskadon; Girardin Jean-Louis; Judith Owens; Adam Bramoweth; Daniel Combs; Lauren Hale; Elizabeth Harrison; Chantelle N Hart; Brant P Hasler; Sarah M Honaker; Elisabeth Hertenstein; Samuel Kuna; Clete Kushida; Jessica C Levenson; Caitlin Murray; Allan I Pack; Vivek Pillai; Kristi Pruiksma; Azizi Seixas; Patrick Strollo; Saurabh S Thosar; Natasha Williams; Daniel Buysse Journal: Sleep Date: 2016-12-01 Impact factor: 5.849