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Natural course of untreated obstructive sleep apnea in adults with coronary artery disease in the RICCADSA cohort
Yüksel Peker1,2,3,4, Mustafa Saygin5, Yeliz Celik1
1Koc University Research Center for Translational Medicine (KUTTAM) and Koc University School of Medicine, Istanbul, Türkiye.
Insights
Most coronary artery disease patients with obstructive sleep apnea (OSA) show improved severity one year post-revascularization, leading to a reduced risk of major adverse cardiovascular and cerebrovascular events (MACCEs). Persistent OSA indicates a higher risk, suggesting targeted interventions are beneficial.
Area of Science:
- Cardiology
- Sleep Medicine
- Pulmonology
Background:
- Recent trials question cardiovascular benefits of treating obstructive sleep apnea (OSA).
- Debate continues regarding OSA treatment efficacy in patients with coronary artery disease (CAD).
Purpose of the Study:
- To determine if OSA persists one year after revascularization in CAD patients.
- To compare major cardiovascular and cerebrovascular events (MACCEs) between patients with persistent versus improved OSA severity.
Main Methods:
- 119 CAD patients with moderate-to-severe OSA from the RICCADSA trial were studied.
- Participants were randomized to no continuous positive airway pressure (CPAP) or were non-users.
- A control group without OSA (apnea-hypopnea index [AHI] < 5/h) was included.
- Home sleep apnea tests were conducted at baseline and after one year.
Main Results:
- 61.3% of patients improved in OSA severity after one year (median AHI decreased from 24.5 to 15.1/h).
- 38.7% had persistent OSA.
- Patients with improved OSA showed a significantly lower risk of MACCEs (Hazard Ratio 0.25).
Conclusions:
- Most CAD patients with moderate-to-severe OSA experience improved severity one year post-revascularization, likely due to enhanced cardiac function.
- Improved OSA severity correlates with a decreased risk of MACCEs compared to persistent OSA.
- Identifying patients with persistent OSA can guide targeted interventions, especially when CPAP therapy is not feasible.
Rationale:
Recent randomized controlled trials failed to show cardiovascular benefits of treating obstructive sleep apnea (OSA) in intention-to-treat analyses, which has been a matter of debate since publication of the results.
Objectives:
To address whether untreated OSA persists after 1 year in adults with coronary artery disease (CAD) following revascularization and to explore whether major cardiovascular and cerebrovascular events (MACCEs) differ between the patients who persist vs improve in OSA severity.
Measurements:
The study population included 119 CAD patients with moderate to severe OSA from the RICCADSA trial. All participants had an apnea-hypopnea index (AHI) ≥ 15/hour and were randomized to no continuous positive airway pressure (CPAP) therapy (n = 81) or were not using the device (n = 38). Patients without OSA (AHI < 5/h) at baseline (n = 85) were included as a control group. Home sleep apnea tests were performed at baseline and after 1 year.
Main Results:
The median AHI decreased from 24.5 (19.4-36.0 events/h) to 15.1 (8.2-27.3 events/h) and oxygen desaturation index (4%) decreased from 14.8 (7.3-22.9 events/h) to 6.6 events/h (2.7-14.4 events/h) after 1 year (P < .001 for both). In all, 73 (61.3%) improved in OSA severity (59 had AHI 5-14.9 events/h and 14 had AHI < 5 events/h), whereas 46 (38.7%) had persistent OSA. The control group had a median AHI 4.4 (2.9-7.9 events/h) after 1 year. N-terminal-pro-B-type natriuretic peptide values decreased significantly in the overall cohort, with similar directional trends across OSA trajectory groups. The patients with improvement in OSA had significantly lower risk for MACCEs (hazard ratio [HR] = 0.25, 95% CI, 0.08-0.76; P = .015) compared to the patients with persistent OSA.
Conclusions:
Most of the CAD patients with moderate to severe OSA improve in OSA severity 1 year after revascularization, probably due to the improved cardiac function, and have a decreased risk for MACCEs compared to individuals with persistent OSA. Identifying patients with persistent OSA after revascularization may help target those most likely to benefit from focused intervention, particularly in settings where CPAP therapy is not initiated or is poorly tolerated.
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