The European respiratory journal · 2025
Major cardiovascular event or death risk in obstructive sleep apnoea and the effect of positive airway pressure.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Divo Miguel J, Martinez-Garcia Miguel A, Gonzalez Monica, Campos-Rodriguez Francisco, Lloberes Patricia, Marin-Oto Marta, Forner Marta, Sanz-Rubio David, Nieto David, Celli Bartolome R, Marin Jose M, Spanish Sleep Network
Аннотация
BACKGROUND: Evidence regarding the efficacy of positive airway pressure (PAP) therapy in reducing the risk of non-fatal major cardiovascular events (NF-MACE) and mortality in patients with obstructive sleep apnoea (OSA) remains controversial. This study aims to quantify the impact of PAP therapy on these risks and develop a predictive risk estimator.
METHODS: We conducted a multicentre, observational, prospective study involving 5358 individuals diagnosed with OSA, with a median (interquartile range (IQR)) follow-up of 14 (10-15) years. We derived and validated a risk estimator of NF-MACE (including myocardial infarction, stroke, revascularisation procedures and congestive heart failure) and all-cause mortality, incorporating PAP adherence alongside clinical and sleep-related data.
RESULTS: The cohort had mean±sd age 55±11 years, body mass index 32.0±5.4 kg·m-2 and apnoea-hypopnoea index (AHI) 35±22 events·h-1; 26% were females and 1467 (37%) were PAP adherent. Over the follow-up period, 754 participants experienced NF-MACE, while 858 deaths were recorded. Significant predictors included prior cardiovascular events, non-high-density lipoprotein cholesterol ≥200 mg·dL-1, COPD diagnosis, AHI >30 events·h-1 and age >60 years. PAP adherence was protective (OR 0.46, 95% CI 0.38-0.56) and the absolute risk reduction varied depending on the baseline risk (median (IQR) 16% (12-18%)). The risk estimator yielded an area under the receiver operating characteristic curve of 0.75 and a Brier score of 0.17, with 64% sensitivity and 75% specificity.
CONCLUSIONS: PAP therapy is associated with long-term risk reduction of NF-MACE and mortality in OSA patients, while the developed risk estimator enhances clinical decision making regarding therapy initiation.
METHODS: We conducted a multicentre, observational, prospective study involving 5358 individuals diagnosed with OSA, with a median (interquartile range (IQR)) follow-up of 14 (10-15) years. We derived and validated a risk estimator of NF-MACE (including myocardial infarction, stroke, revascularisation procedures and congestive heart failure) and all-cause mortality, incorporating PAP adherence alongside clinical and sleep-related data.
RESULTS: The cohort had mean±sd age 55±11 years, body mass index 32.0±5.4 kg·m-2 and apnoea-hypopnoea index (AHI) 35±22 events·h-1; 26% were females and 1467 (37%) were PAP adherent. Over the follow-up period, 754 participants experienced NF-MACE, while 858 deaths were recorded. Significant predictors included prior cardiovascular events, non-high-density lipoprotein cholesterol ≥200 mg·dL-1, COPD diagnosis, AHI >30 events·h-1 and age >60 years. PAP adherence was protective (OR 0.46, 95% CI 0.38-0.56) and the absolute risk reduction varied depending on the baseline risk (median (IQR) 16% (12-18%)). The risk estimator yielded an area under the receiver operating characteristic curve of 0.75 and a Brier score of 0.17, with 64% sensitivity and 75% specificity.
CONCLUSIONS: PAP therapy is associated with long-term risk reduction of NF-MACE and mortality in OSA patients, while the developed risk estimator enhances clinical decision making regarding therapy initiation.