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CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea

Author:McEvoy, R. D.;Antic, N. A.;Heeley, E.;Luo, Y.;Ou, Q.;Zhang, X.;Mediano, O.;Chen, R.;Drager, L. F.;Liu, Z.;Chen, G.;Du B;McArdle, N.;Mukherjee, S.;Tripathi, M.;Billot, L.;Li, Q.;Lorenzi-Filho, G.;Barbe, F.;Redline, S.;Wang, J.;Arima, H.;Neal, B.;White, D. P.;Grunstein, R. R.;Zhong, N.;Anderson, C. S.

Address:From the Adelaide Institute for Sleep Health (R.D.M., N.A.A.) and the School of Medicine, Faculty of Medicine, Nursing, and Health Sciences (R.D.M., N.A.A., E.H., B.N., C.S.A.), Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network (R.D.M., N.A.A., S.M.), Adelaide, SA, George Institute for Global Health (E.H., L.B., Q.L., H.A., B.N., C.S.A.), Sydney Medical School (E.H., L.B., Q.L., H.A., B.N., C.S.A.), and Woolcock Institute of M

Article Type:Journal Article

Journal:N Engl J Med

Time:2016-09-19

全文

Abstract:

Background Obstructive sleep apnea is associated with an increased risk of
cardiovascular events; whether treatment with continuous positive airway
pressure (CPAP) prevents major cardiovascular events is uncertain. Methods After
a 1-week  run-in period during which the participants used sham CPAP, we
randomly assigned  2717 eligible adults between 45 and 75 years of age who had
moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular
disease to receive CPAP treatment plus usual care (CPAP group) or usual care
alone (usual-care group). The primary composite end point was death from
cardiovascular causes, myocardial  infarction, stroke, or hospitalization for
unstable angina, heart failure, or transient ischemic attack. Secondary end
points included other cardiovascular outcomes, health-related quality of life,
snoring symptoms, daytime sleepiness, and mood. Results Most of the participants
were men who had moderate-to-severe obstructive sleep apnea and minimal
sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy
was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea
or hypopnea events per hour of recording) decreased from 29.0 events per hour at
baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7
years, a primary end-point event  had occurred in 229 participants in the CPAP
group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard
ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34). No
significant effect on any individual or other composite cardiovascular end point
was observed. CPAP significantly reduced snoring and daytime sleepiness and
improved health-related  quality of life and mood. Conclusions Therapy with CPAP
plus usual care, as compared with usual care alone, did not prevent
cardiovascular events in patients with moderate-to-severe obstructive sleep
apnea and established cardiovascular disease. (Funded by the National Health and
Medical Research Council of Australia and others; SAVE ClinicalTrials.gov
number, NCT00738179 ; Australian New Zealand  Clinical Trials Registry number,
ACTRN12608000409370 .).