Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis
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Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis. / Sánchez-de-la-Torre, Manuel; Gracia-Lavedan, Esther; Benitez, Ivan D; Sánchez-de-la-Torre, Alicia; Moncusí-Moix, Anna; Torres, Gerard; Loffler, Kelly; Woodman, Richard; Adams, Robert; Labarca, Gonzalo; Dreyse, Jorge; Eulenburg, Christine; Thunström, Erik; Glantz, Helena; Peker, Yüksel; Anderson, Craig; McEvoy, Doug; Barbé, Ferran.
in: JAMA-J AM MED ASSOC, Jahrgang 330, Nr. 13, 03.10.2023, S. 1255-1265.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis
AU - Sánchez-de-la-Torre, Manuel
AU - Gracia-Lavedan, Esther
AU - Benitez, Ivan D
AU - Sánchez-de-la-Torre, Alicia
AU - Moncusí-Moix, Anna
AU - Torres, Gerard
AU - Loffler, Kelly
AU - Woodman, Richard
AU - Adams, Robert
AU - Labarca, Gonzalo
AU - Dreyse, Jorge
AU - Eulenburg, Christine
AU - Thunström, Erik
AU - Glantz, Helena
AU - Peker, Yüksel
AU - Anderson, Craig
AU - McEvoy, Doug
AU - Barbé, Ferran
PY - 2023/10/3
Y1 - 2023/10/3
N2 - IMPORTANCE: The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated.OBJECTIVE: To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of adverse cardiovascular events in randomized clinical trials.DATA SOURCES: PubMed (MEDLINE), EMBASE, Current Controlled Trials: metaRegister of Controlled Trials, ISRCTN Registry, European Union clinical trials database, CENTRAL (Cochrane Central Register of Controlled Trials), and ClinicalTrials.gov databases were systematically searched through June 22, 2023.STUDY SELECTION: For qualitative and individual participant data (IPD) meta-analysis, randomized clinical trials addressing the therapeutic effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA were included.DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened records, evaluated potentially eligible primary studies in full text, extracted data, and cross-checked errors. IPD were requested from authors of the selected studies (SAVE [NCT00738179], ISAACC [NCT01335087], and RICCADSA [NCT00519597]).MAIN OUTCOMES AND MEASURES: One-stage and 2-stage IPD meta-analyses were completed to estimate the effect of CPAP treatment on risk of recurrent major adverse cardiac and cerebrovascular events (MACCEs) using mixed-effect Cox regression models. Additionally, an on-treatment analysis with marginal structural Cox models using inverse probability of treatment weighting was fitted to assess the effect of good adherence to CPAP (≥4 hours per day).RESULTS: A total of 4186 individual participants were evaluated (82.1% men; mean [SD] body mass index, 28.9 [4.5]; mean [SD] age, 61.2 [8.7] years; mean [SD] apnea-hypopnea index, 31.2 [17] events per hour; 71% with hypertension; 50.1% receiving CPAP [mean {SD} adherence, 3.1 {2.4} hours per day]; 49.9% not receiving CPAP [usual care], mean [SD] follow-up, 3.25 [1.8] years). The main outcome was defined as the first MACCE, which was similar for the CPAP and no CPAP groups (hazard ratio, 1.01 [95% CI, 0.87-1.17]). However, an on-treatment analysis by marginal structural model revealed a reduced risk of MACCEs associated with good adherence to CPAP (hazard ratio, 0.69 [95% CI, 0.52-0.92]).CONCLUSIONS AND RELEVANCE: Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA.
AB - IMPORTANCE: The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated.OBJECTIVE: To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of adverse cardiovascular events in randomized clinical trials.DATA SOURCES: PubMed (MEDLINE), EMBASE, Current Controlled Trials: metaRegister of Controlled Trials, ISRCTN Registry, European Union clinical trials database, CENTRAL (Cochrane Central Register of Controlled Trials), and ClinicalTrials.gov databases were systematically searched through June 22, 2023.STUDY SELECTION: For qualitative and individual participant data (IPD) meta-analysis, randomized clinical trials addressing the therapeutic effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA were included.DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened records, evaluated potentially eligible primary studies in full text, extracted data, and cross-checked errors. IPD were requested from authors of the selected studies (SAVE [NCT00738179], ISAACC [NCT01335087], and RICCADSA [NCT00519597]).MAIN OUTCOMES AND MEASURES: One-stage and 2-stage IPD meta-analyses were completed to estimate the effect of CPAP treatment on risk of recurrent major adverse cardiac and cerebrovascular events (MACCEs) using mixed-effect Cox regression models. Additionally, an on-treatment analysis with marginal structural Cox models using inverse probability of treatment weighting was fitted to assess the effect of good adherence to CPAP (≥4 hours per day).RESULTS: A total of 4186 individual participants were evaluated (82.1% men; mean [SD] body mass index, 28.9 [4.5]; mean [SD] age, 61.2 [8.7] years; mean [SD] apnea-hypopnea index, 31.2 [17] events per hour; 71% with hypertension; 50.1% receiving CPAP [mean {SD} adherence, 3.1 {2.4} hours per day]; 49.9% not receiving CPAP [usual care], mean [SD] follow-up, 3.25 [1.8] years). The main outcome was defined as the first MACCE, which was similar for the CPAP and no CPAP groups (hazard ratio, 1.01 [95% CI, 0.87-1.17]). However, an on-treatment analysis by marginal structural model revealed a reduced risk of MACCEs associated with good adherence to CPAP (hazard ratio, 0.69 [95% CI, 0.52-0.92]).CONCLUSIONS AND RELEVANCE: Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA.
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Cardiovascular Diseases/etiology
KW - Continuous Positive Airway Pressure/adverse effects
KW - Hypertension/complications
KW - Proportional Hazards Models
KW - Sleep Apnea, Obstructive/complications
KW - Risk
KW - Aged
KW - Secondary Prevention/methods
KW - Patient Compliance
U2 - 10.1001/jama.2023.17465
DO - 10.1001/jama.2023.17465
M3 - SCORING: Journal article
C2 - 37787793
VL - 330
SP - 1255
EP - 1265
JO - JAMA-J AM MED ASSOC
JF - JAMA-J AM MED ASSOC
SN - 0098-7484
IS - 13
ER -