Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with NonSleepy Obstructive Sleep Apnea:The RICCADSA Randomized Controlled Trial

TY - JOUR

T1 - Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with NonSleepy Obstructive Sleep Apnea:The RICCADSA Randomized Controlled Trial

AU - Peker, Yüksel

AU - Glantz, Helena

AU - Eulenburg, Christine

AU - Wegscheider, Karl

AU - Herlitz, Johan

AU - Thunström, Erik

PY - 2016/9/1

Y1 - 2016/9/1

N2 - RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is uncertain.OBJECTIVE: To determine the effects of continuous positive airway pressure on long-term adverse cardiovascular outcome risk in coronary artery disease patients with nonsleepy obstructive sleep apnea.METHODS: This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized coronary artery disease and obstructive sleep apnea (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating continuous positive airway pressure (n=122) or no positive airway pressure (n=122).MEASUREMENTS: The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality.MAIN RESULTS: Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive positive airway pressure (18.1% vs. 22.1%; hazard ratio 0.80; 95% confidence interval 0.46-1.41; P=0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used continuous positive airway pressure for ≥4 vs <4 h/night or did not receive treatment (hazard ratio 0.29; 95% confidence interval 0.10-0.86; P=0.026).CONCLUSIONS: Routine prescription of continuous positive airway pressure to coronary artery disease patients with nonsleepy obstructive sleep apnea did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00519597.

AB - RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is uncertain.OBJECTIVE: To determine the effects of continuous positive airway pressure on long-term adverse cardiovascular outcome risk in coronary artery disease patients with nonsleepy obstructive sleep apnea.METHODS: This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized coronary artery disease and obstructive sleep apnea (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating continuous positive airway pressure (n=122) or no positive airway pressure (n=122).MEASUREMENTS: The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality.MAIN RESULTS: Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive positive airway pressure (18.1% vs. 22.1%; hazard ratio 0.80; 95% confidence interval 0.46-1.41; P=0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used continuous positive airway pressure for ≥4 vs <4 h/night or did not receive treatment (hazard ratio 0.29; 95% confidence interval 0.10-0.86; P=0.026).CONCLUSIONS: Routine prescription of continuous positive airway pressure to coronary artery disease patients with nonsleepy obstructive sleep apnea did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00519597.

U2 - 10.1164/rccm.201601-0088OC

DO - 10.1164/rccm.201601-0088OC

M3 - SCORING: Journal article

C2 - 26914592

VL - 194

SP - 613

EP - 620

JO - AM J RESP CRIT CARE

JF - AM J RESP CRIT CARE

SN - 1073-449X

IS - 5

ER -