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Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a post hoc study of the
Lucía Pinilla1,2,3,4, Neda Esmaeili3,5,4, Gonzalo Labarca3
1Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, University of Lleida, IRBLleida, Lleida, Spain.
Insights
High hypoxic burden (HB) in obstructive sleep apnea (OSA) patients with acute coronary syndrome (ACS) predicts a significant cardiovascular benefit from continuous positive airway pressure (CPAP) treatment.
Area of Science:
- Cardiology
- Sleep Medicine
- Respiratory Medicine
Background:
- Hypoxic burden (HB) is a key predictor of cardiovascular risk in obstructive sleep apnea (OSA).
- Continuous positive airway pressure (CPAP) is a primary treatment for OSA.
- The predictive role of HB for CPAP's cardiovascular benefits in OSA patients remains unclear.
Purpose of the Study:
- To evaluate if hypoxic burden (HB) can predict the cardiovascular benefits of continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA).
- To assess the interaction between baseline HB levels and CPAP treatment efficacy on cardiovascular outcomes in non-sleepy acute coronary syndrome (ACS) patients with OSA.
Main Methods:
- A post-hoc analysis of the ISAACC trial involving non-sleepy ACS patients with OSA (apnea-hypopnea index ≥15 events/h).
- Patients were randomized to CPAP or usual care, with follow-up for at least 1 year.
- Hypoxic burden (HB) was calculated, and patients were stratified into high or low HB groups based on the median value (73.1%min·h⁻¹). Multivariable Cox regression models analyzed treatment effects based on HB levels.
Main Results:
- A significant interaction was observed between CPAP treatment and HB categories.
- In the high HB group, CPAP significantly reduced cardiovascular event incidence (HR 0.57, 95% CI 0.34-0.96).
- In the low HB group, CPAP showed a trend towards increased cardiovascular risk (HR 1.33, 95% CI 0.79-2.25), indicating a dose-response relationship.
Conclusions:
- High baseline hypoxic burden (HB) identifies non-sleepy ACS patients with OSA who benefit from long-term cardiovascular protection with CPAP therapy.
- The findings suggest that HB can personalize CPAP treatment decisions for cardiovascular risk reduction in OSA patients.
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.
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