Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a post hoc study of the ISAACC trial.
Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a post hoc study of the ISAACC trial.
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DOI：
10.1183/13993003.00828-2023
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发表时间：
2023-12
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低血糖负荷（HB）已成为阻塞性睡眠呼吸暂停（OSA）患者心血管风险的一个强有力的预测因子。我们的目的是评估HB预测持续气道正压通气（CPAP）治疗OSA的心血管获益的潜力。这是对ISAACC试验（ClinicalTrials.gov：NCT 01335087）的事后分析，包括通过呼吸道多导睡眠图诊断为OSA（呼吸暂停-呼吸不足指数≥15起事件·h−1）的急性冠状动脉综合征（ACS）非嗜睡患者。 患者随机接受CPAP或常规护理，并随访至少1年。 HB计算为所有自动识别的去饱和下的总面积除以总睡眠时间。根据中位值（73.1%min·h−1）将患者分为高或低基线HB。多变量考克斯回归模型用于评估CPAP对心血管结局发生率的影响是否依赖于基线HB水平。人群（362例分配接受CPAP治疗的患者和365例分配接受常规治疗的患者）为中年（平均年龄59.7岁）、超重/肥胖，大部分为男性（84.5%）。 在治疗组和HB类别之间发现了显著的相互作用。在高HB组中，CPAP治疗与心血管事件发生率显著降低相关（HR 0.57，95% CI 0.34-0.96）。在低HB组中，CPAP治疗患者的心血管结局风险高于接受常规治疗的患者（HR 1.33，95% CI 0.79-2.25）。治疗的差异效应取决于基线HB水平，遵循剂量-反应关系。在伴有OSA的非嗜睡ACS患者中，高HB水平与CPAP对心血管预后的长期保护作用相关。低通气负荷是阻塞性睡眠呼吸暂停严重程度的一个指标，具有潜在的临床实用性，可用于识别最有可能从持续气道正压通气治疗中获益的患者，以进行二级心血管预防https://bit.ly/3szv4hf
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 (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. 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. Hypoxic burden stands out as an obstructive sleep apnoea severity metric with potential clinical utility to identify patients most likely to benefit from continuous positive airway pressure treatment for secondary cardiovascular prevention https://bit.ly/3szv4hf
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影响因子：
24
作者：
Javaheri S;Barbe F;Campos-Rodriguez F;Dempsey JA;Khayat R;Javaheri S;Malhotra A;Martinez-Garcia MA;Mehra R;Pack AI;Polotsky VY;Redline S;Somers VK
通讯作者：
Somers VK
DOI：
10.1186/1476-9255-10-13
发表时间：
2013
期刊：
Journal of inflammation (London, England)
影响因子：
--
作者：
Baessler A;Nadeem R;Harvey M;Madbouly E;Younus A;Sajid H;Naseem J;Asif A;Bawaadam H
通讯作者：
Bawaadam H
影响因子：
4.8
作者：
Collop, Nancy A.
通讯作者：
Collop, Nancy A.
影响因子：
76.2
作者：
Benjafield, Adam V.;Ayas, Najib T.;Malhotra, Atul
通讯作者：
Malhotra, Atul
影响因子：
39.2
作者：
Campos-Rodriguez, Francisco;Martinez-Garcia, Miguel A.;Montserrat, Josep M.
通讯作者：
Montserrat, Josep M.