Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches.
Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches.
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DOI：
10.1016/j.ahj.2015.07.033
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发表时间：
2016-02
影响因子：
4.8
通讯作者：
Redline S
中科院分区：
文献类型：
--
作者：
Yaggi HK;Mittleman MA;Bravata DM;Concato J;Ware J;Stoney CM;Redline S
阻塞性睡眠呼吸暂停(OSA)显著影响心血管健康，观察性调查显示，缺血性心脏病、糖尿病、高血压、充血性心力衰竭、急性冠脉综合征、中风、心血管死亡和全因死亡的风险独立增加。气道正压(PAP)是一种治疗睡眠呼吸暂停的药物，它可以逆转呼吸道阻塞，并可能有助于降低心血管风险。在计划大型III期随机对照试验以测试PAP对心血管结局的影响之前，需要解决几个知识上的差距。本文描述了两项合作填补这些空白的独立研究。描述了这两项研究(睡眠和最佳空气)的人群、设计特点和相对优势/挑战。这两项研究都被鼓励拥有在行为干预方面具有专业知识的多学科团队，以提高PAP的遵从性。这两项研究都提供了关键信息，这些信息将在未来的大规模、事件驱动的随机试验中对研究界有用，以评估识别和治疗严重阻塞性睡眠呼吸暂停的策略的有效性和/或有效性，以降低高危患者发生主要不良心血管事件的风险。
Obstructive sleep apnea (OSA) significantly impacts cardiovascular health, demonstrated by observational investigations showing an independently increased risk of ischemic heart disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, cardiovascular mortality, and all-cause mortality. Positive airway pressure (PAP), a medical therapy for sleep apnea, reverses airway obstruction and may help reduce cardiovascular risk. Prior to planning large Phase III randomized controlled trials to test the impact of PAP on cardiovascular outcomes, several gaps in knowledge need to be addressed. This paper describes two independent studies that worked collaboratively to fill these gaps. The populations, design features, and relative benefits/challenges of the two studies (SleepTight and BestAIR) are described. Both studies were encouraged to have multidisciplinary teams with expertise in behavioral interventions to improve PAP compliance. Both studies provide key information that will be useful to the research community in future large-scale, event-driven, randomized trials to evaluate the efficacy and/or effectiveness of strategies to identify and treat significant obstructive sleep apnea for decreasing risk of major adverse cardiovascular events in high-risk patients.