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Am J Respir Crit Care Med. 2016 Sep 1;194(5):613-20. doi: 10.1164/rccm.201601-0088OC.

Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial.

Author information

1
1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
2
2 Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.
3
3 Department of Internal Medicine, Skaraborg Hospital, Skövde, Sweden.
4
4 Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany.
5
5 Center of Prehospital Care of Western Sweden, University College of Borås, Borås, Sweden.
6
6 Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden; and.
7
7 Department of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.

Abstract

RATIONALE:

Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), many of whom do not report daytime sleepiness. First-line treatment for symptomatic OSA is continuous positive airway pressure (CPAP), but its value in patients without daytime sleepiness is uncertain.

OBJECTIVES:

To determine the effects of CPAP on long-term adverse cardiovascular outcome risk in patients with CAD with nonsleepy OSA.

METHODS:

This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized CAD and OSA (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating CPAP (n = 122) or no positive airway pressure (n = 122).

MEASUREMENTS AND MAIN RESULTS:

The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive CPAP (18.1% vs. 22.1%; hazard ratio, 0.80; 95% confidence interval, 0.46-1.41; P = 0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used CPAP for ≥4 versus <4 hours per night or did not receive treatment (hazard ratio, 0.29; 95% confidence interval, 0.10-0.86; P = 0.026).

CONCLUSIONS:

Routine prescription of CPAP to patients with CAD with nonsleepy OSA did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 00519597).

KEYWORDS:

cardiovascular outcomes; coronary artery disease; obstructive sleep apnea

PMID:
26914592
DOI:
10.1164/rccm.201601-0088OC
[Indexed for MEDLINE]

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