Bruno Revol1, Ingrid Jullian-Desayes2, Sébastien Bailly2, Renaud Tamisier2, Yves Grillet3, Marc Sapène4, Marie Joyeux-Faure2, Jean-Louis Pépin5. 1. HP2 Laboratory, Inserm Unit 1042, University Grenoble Alpes, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France; Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France. 2. HP2 Laboratory, Inserm Unit 1042, University Grenoble Alpes, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France. 3. Private practice sleep and respiratory disease centre Valence, Valence, France. 4. Private practice sleep and respiratory disease centre, Nouvelle Clinique Bel Air, Bordeaux, France. 5. HP2 Laboratory, Inserm Unit 1042, University Grenoble Alpes, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France. Electronic address: jpepin@chu-grenoble.fr.
Abstract
BACKGROUND: Diuretics have been reported as effective for reducing OSA severity by preventing fluid retention and reducing rostral fluid shift. The benefit of diuretics might vary depending on the OSA clinical phenotype and comorbidities. To test this hypothesis, we conducted a propensity score-matched cohort analysis of data from the French national sleep apnea registry "Observatoire Sommeil de la Fédération de Pneumologie." RESEARCH QUESTION: Which phenotypic subtypes of OSA may benefit from diuretics? STUDY DESIGN AND METHODS: A propensity score analysis was used to determine the impact of diuretics on OSA severity. Matching (ratio 1:4) was performed by using a 0.1 collider for the propensity score. Severe OSA was defined as an apnea-hypopnea index (AHI) > 30 events/h, and the usefulness of diuretics was assessed by using a logistic regression model. RESULTS: The 69,564 OSA patients studied in the OSFP prospective observational cohort had a median age of 56.9 years (interquartile range: 47.4; 65.6), 67% were men, and the median AHI was 28 (14; 43) events/h. Among them, 9,783 (14.1%) were treated with diuretics. Diuretics reduced OSA severity in overweight or moderately obese patients (P = .03) and in patients with hypertension (P < .01), particularly in patients with hypertension with a BMI between 25 and 35 (P < .01). Diuretics had no significant effect on OSA severity in patients with self-reported low physical activity or heart failure. INTERPRETATION: Diuretics appear to have a positive impact on OSA severity in overweight or moderately obese patients with hypertension. A prospective study is needed to confirm that diuretics are of interest in combined therapies for hypertensive patients with OSA.
BACKGROUND: Diuretics have been reported as effective for reducing OSA severity by preventing fluid retention and reducing rostral fluid shift. The benefit of diuretics might vary depending on the OSA clinical phenotype and comorbidities. To test this hypothesis, we conducted a propensity score-matched cohort analysis of data from the French national sleep apnea registry "Observatoire Sommeil de la Fédération de Pneumologie." RESEARCH QUESTION: Which phenotypic subtypes of OSA may benefit from diuretics? STUDY DESIGN AND METHODS: A propensity score analysis was used to determine the impact of diuretics on OSA severity. Matching (ratio 1:4) was performed by using a 0.1 collider for the propensity score. Severe OSA was defined as an apnea-hypopnea index (AHI) > 30 events/h, and the usefulness of diuretics was assessed by using a logistic regression model. RESULTS: The 69,564 OSApatients studied in the OSFP prospective observational cohort had a median age of 56.9 years (interquartile range: 47.4; 65.6), 67% were men, and the median AHI was 28 (14; 43) events/h. Among them, 9,783 (14.1%) were treated with diuretics. Diuretics reduced OSA severity in overweight or moderately obesepatients (P = .03) and in patients with hypertension (P < .01), particularly in patients with hypertension with a BMI between 25 and 35 (P < .01). Diuretics had no significant effect on OSA severity in patients with self-reported low physical activity or heart failure. INTERPRETATION: Diuretics appear to have a positive impact on OSA severity in overweight or moderately obesepatients with hypertension. A prospective study is needed to confirm that diuretics are of interest in combined therapies for hypertensivepatients with OSA.
Authors: Cem Tanriover; Duygu Ucku; Merve Akyol; Enes Cevik; Asiye Kanbay; Vikas S Sridhar; David Z I Cherney; Mehmet Kanbay Journal: Sleep Breath Date: 2022-04-04 Impact factor: 2.816
Authors: Bruno Revol; Monique Mendelson; Sébastien Bailly; Renaud Tamisier; Marie Joyeux-Faure; Jean-Louis Pépin Journal: Ann Am Thorac Soc Date: 2021-12