CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea

被引:1487
作者
McEvoy, R. Doug [1 ,2 ,3 ]
Antic, Nick A. [1 ,2 ,3 ]
Heeley, Emma [2 ,4 ,5 ]
Luo, Yuanming [10 ]
Ou, Qiong [11 ]
Zhang, Xilong [12 ]
Mediano, Olga [19 ]
Chen, Rui [13 ]
Drager, Luciano F. [22 ,23 ,24 ]
Liu, Zhihong [14 ]
Chen, Guofang [16 ]
Du, Baoliang [17 ]
McArdle, Nigel [9 ]
Mukherjee, Sutapa [3 ,9 ]
Tripathi, Manjari [25 ]
Billot, Laurent [4 ,5 ]
Li, Qiang [4 ,5 ]
Lorenzi-Filho, Geraldo [22 ,23 ]
Barbe, Ferran [20 ,21 ]
Redline, Susan [26 ,27 ]
Wang, Jiguang [18 ]
Arima, Hisatomi [4 ,5 ]
Neal, Bruce [2 ,4 ,5 ]
White, David P. [26 ,27 ]
Grunstein, Ron R. [6 ,7 ]
Zhong, Nanshan [10 ]
Anderson, Craig S. [2 ,4 ,5 ,8 ,15 ]
机构
[1] Flinders Univ S Australia, Adelaide Inst Sleep Hlth, Adelaide, SA, Australia
[2] Flinders Univ S Australia, Sch Med, Fac Med Nursing & Hlth Sci, Adelaide, SA, Australia
[3] Southern Adelaide Local Hlth Network, Sleep Hlth Serv, Resp & Sleep Serv, Adelaide, SA, Australia
[4] Univ Sydney, George Inst Global Hlth, Sydney, NSW, Australia
[5] Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia
[6] Univ Sydney, Woolcock Inst Med Res, Sydney, NSW, Australia
[7] Royal Prince Alfred Hosp, Sydney Hlth Partners, Dept Resp & Sleep Med, Sydney, NSW, Australia
[8] Royal Prince Alfred Hosp, Dept Neurol, Sydney, NSW, Australia
[9] Sir Charles Gairdner Hosp, Western Australian Sleep Disorders Res Inst, Perth, WA, Australia
[10] Guangzhou Med Univ, Affiliated Hosp 1, State Key Lab Resp Dis, Guangzhou, Guangdong, Peoples R China
[11] Guangdong Gen Hosp & Guangdong Acad Med Sci, Guangzhou, Guangdong, Peoples R China
[12] Nanjing Med Univ, Affiliated Hosp 1, Nanjing, Jiangsu, Peoples R China
[13] Soochow Univ, Affiliated Hosp 2, Suzhou, Peoples R China
[14] Peking Univ, Dept Cardiol, Fuwai Hosp, Hlth Sci Ctr, Beijing, Peoples R China
[15] Peking Univ, George Inst Global Hlth China, Hlth Sci Ctr, Beijing, Peoples R China
[16] Xuzhou Cent Hosp, Dept Neurol, Xuzhou, Peoples R China
[17] Hejian Municipal Peoples Hosp, Hejian, Peoples R China
[18] Shanghai Jiao Tong Univ, Shanghai Inst Hypertens, Ruijin Hosp, Shanghai, Peoples R China
[19] Univ Hosp Guadalajara, Guadalajara, Spain
[20] Inst Recerca Biomed Lleida, Resp Dept, Lleida, Spain
[21] Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
[22] Inst Coracao Incor, Sao Paulo, Brazil
[23] Univ Hosp, Sao Paulo, Brazil
[24] Univ Sao Paulo, Hypertens Unit, Div Renal, Sch Med, Sao Paulo, Brazil
[25] All India Inst Med Sci, Dept Neurol, Delhi, India
[26] Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Boston, MA USA
[27] Harvard Med Sch, Boston, MA USA
基金
英国医学研究理事会;
关键词
POSITIVE AIRWAY PRESSURE; BLOOD-PRESSURE; END-POINTS; ASSOCIATION; STROKE; HEART; RISK; HYPERTENSION; HYPOPNEA; THERAPY;
D O I
10.1056/NEJMoa1606599
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.)
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收藏
页码:919 / 931
页数:13
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