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Frailty and Recurrent Cardiovascular Events in Patients With Obstructive Sleep Apnoea: The SAVE Study
Shoujiang You1, Danni Zheng2, Katie Harris2
1Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Background:
Frailty is a common syndrome in patients with cardiovascular disease (CVD). Whether frailty modifies the risk of recurrent cardiovascular events in patients with established CVD and obstructive sleep apnoea (OSA) is uncertain. We aimed to determine associations of frailty and the risk of recurrent cardiovascular events in adults with moderate-severe OSA and established CVD.
Methods:
Post hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants from 89 clinical centres in seven countries with moderate-to-severe OSA and established CVD were randomised to usual care plus continuous positive airway pressure (CPAP) treatment or usual care alone. Participants were categorised using the Rockwood frailty index (FI) into three groups: nonfrail (FI ≤ 0.210), moderately frail (FI 0.211-0.310) and severely frail (FI ≥ 0.311). Cox proportional hazards models were used to assess associations of FI and both composite and individual cardiovascular outcomes over an average follow-up period of 3.7 years.
Results:
There were 2653 OSA participants (mean age 61.3 [SD 7.8] years, and 507 [19.1%] were female) with established CVD included with a mean FI of 0.290 (SD 0.125). There were 783 (29.5%) and 1006 (37.9%) classified as moderately and severely frail, respectively. Compared to those without frailty, those with severe frailty had increased risks of the composite cardiovascular endpoint (hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.88-3.11), and separately for stroke (HR, 2.40; 95% CI, 1.54-3.74), hospitalisation for unstable angina (HR, 2.94; 95% CI, 1.98-4.35), all-cause mortality (HR, 1.77; 95% CI, 1.01-3.11) and CVD death (HR, 2.51; 95% CI, 1.13-5.60), during a mean 3.7 years of follow-up. There was a similar level of adherence to CPAP treatment (p = 0.488) across baseline frailty groups and no heterogeneity in the effect of CPAP treatment on composite and separate cardiovascular events.
Conclusions:
In the SAVE cohort of adults with co-occurring OSA and CVD, a higher FI was associated with significantly higher risk of recurrent cardiovascular events. Frailty did not modify CPAP treatment adherence or the effect of CPAP on recurrent cardiovascular events.
Trial Registration:
ClinicalTrials.gov identifier: NCT00738179.
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