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Hypoxic Burden to Guide Cpap Treatment Allocation in Patients With Obstructive Sleep Apnoea: A Post Hoc Study of the Isaacc Trial Publisher Pubmed



Pinilla L1, 2, 3 ; Esmaeili N3, 4 ; Labarca G3 ; Martinezgarcia MA2, 5 ; Torres G1, 2 ; Gracialavedan E2, 6 ; Minguez O6 ; Martinez D6 ; Abad J2, 7 ; Masdeu MJ2, 8 ; Mediano O2, 9 ; Munoz C10 ; Cabriada V11 ; Durancantolla J2, 12 Show All Authors
Authors
  1. Pinilla L1, 2, 3
  2. Esmaeili N3, 4
  3. Labarca G3
  4. Martinezgarcia MA2, 5
  5. Torres G1, 2
  6. Gracialavedan E2, 6
  7. Minguez O6
  8. Martinez D6
  9. Abad J2, 7
  10. Masdeu MJ2, 8
  11. Mediano O2, 9
  12. Munoz C10
  13. Cabriada V11
  14. Durancantolla J2, 12
  15. Mayos M2, 13
  16. Coloma R14
  17. Montserrat JM2, 15
  18. La Pena MD16
  19. Hu WH3
  20. Messineo L3
  21. Sehhati M4
  22. Wellman A3
  23. Redline S3
  24. Sands S3
  25. Barbe F2, 6
  26. Sanchezdelatorre M1, 2, 17
  27. Azarbarzin A3, 17
Show Affiliations
Authors Affiliations
  1. 1. Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa Maria, University of Lleida, IRBLleida, Lleida, Spain
  2. 2. Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
  3. 3. Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
  4. 4. Bioelectric and Biomedical Engineering Department, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. Pneumology Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
  6. 6. Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, University of Lleida, IRBLleida, Lleida, Spain
  7. 7. Pneumology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
  8. 8. Pneumology Department, University Hospital Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
  9. 9. Pneumology Department, University Hospital of Guadalajara, Guadalajara, Spain
  10. 10. Pneumology Department, University Hospital of Burgos, Burgos, Spain
  11. 11. Pneumology Department, University Hospital of Cruces, Bizkaia, Spain
  12. 12. Bioaraba Health Research Institute, University Hospital of Araba, Vitoria, Spain
  13. 13. Sleep Unit, Pneumology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
  14. 14. Pneumology Department, University Hospital of Albacete, Albacete, Spain
  15. 15. Pneumology Department, Clinic Hospital, Barcelona, Spain
  16. 16. University Hospital Son Espases, Research Institute of Palma, Palma de Mallorca, Spain
  17. 17. M. Sanchez-de-la-Torre and A. Azarbarzin contributed equally to this article as lead authors and supervised the work, Azerbaijan

Source: European Respiratory Journal Published:2023


Abstract

Background 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). Methods 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. Results 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. Conclusion In non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis. © 2023 European Respiratory Society. All rights reserved.
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