Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón.
J Clin Sleep Med. 2022 Feb 1;18(2):553-561. doi: 10.5664/jcsm.9656.
Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction.
An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0-29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE.
A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6-64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60-1.83; = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79-1.96; = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses.
CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA.
López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). . 2022;18(2):553-561.
阻塞性睡眠呼吸暂停（OSA）与心血管事件（CVE）有关，尽管最近的随机对照试验并未表明长期持续气道正压通气（CPAP）可预防 CVE。我们的目的是确定 CPAP 对患有中度 OSA（呼吸暂停-低通气指数 15.0-29.9 次/小时）的老年患者在降低 CVE 方面的效果。
对诊断为中度 OSA（呼吸暂停-低通气指数 15.0-29.9 次/小时）的老年患者（>70 岁）进行了一项观察性和多中心队列研究。分为两组：（1）CPAP 治疗组；（2）标准治疗组。主要终点是 OSA 诊断后 CVE 的发生。通过倾向评分匹配和逆加权概率评估 CPAP 治疗的相关性。次要终点分别为 CVE 的发生率和首次 CVE 的时间。
共纳入 614 例患者。匹配后，对 236 例老年患者（111 例男性，平均年龄 75.9±4.7 岁）进行了为期 47 个月（四分位距：29.6-64.0 个月）的随访，以评估主要和次要终点。41 例患者出现至少 1 次 CVE（17.4%）：标准治疗组 20 例（16.9%），CPAP 组 21 例（17.8%），CPAP 治疗的相对风险为 1.05（95%置信区间 [CI]，0.60-1.83；=0.43）。对最初的 614 例患者进行逆概率加权后，CPAP 治疗的调整相对风险为 1.24（95% CI，0.79-1.96；=0.35）。在次要终点分析中未发现统计学差异。
对于患有中度 OSA 的老年患者，不应开具 CPAP 以降低 CVE 发生的可能性。
López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study).. 2022;18(2):553-561.
