Cardiovascular benefit of continuous positive airway pressure according to high-risk obstructive sleep apnoea: a multi-trial analysis.

This study tested whether the cardiovascular benefit of CPAP occurs preferentially in high-risk OSA, characterized by greater OSA-related heart rate acceleration or hypoxaemia.

本研究测试了CPAP的心血管益处是否更倾向于高风险OSA，其特点是OSA相关的心率加速或低氧血症更为严重。

Methods

In a post hoc analysis of pooled Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Obstructive Sleep Apnoea, Impact of Continuous Positive Airway Pressure on Patients with Acute Coronary Syndrome and Nonsleepy Obstructive Sleep Apnoea, and Sleep Apnoea Cardiovascular Endpoints Study randomized trials; outcomes were stratified by high-risk OSA status, defined by heart rate response following OSA respiratory events >9.4 b.p.m.

在对连续正压通气治疗冠状动脉疾病和阻塞性睡眠呼吸暂停、急性冠脉综合征和非嗜睡性阻塞性睡眠呼吸暂停患者以及睡眠呼吸暂停心血管终点研究的随机试验进行的事后分析中，根据OSA呼吸事件后心率反应>9.4次/分钟（第三三分位数）或基线氧饱和度下降面积（缺氧负荷）>87.1%分钟/小时（第三三分位数）定义的高风险OSA状态对结果进行了分层。

(third tertile) or oxygen desaturation area under baseline (hypoxic burden) > 87.1% min/h (third tertile).

(第三三分位数)或基线氧饱和度下降面积(缺氧负担)> 87.1% min/h (第三三分位数)。

Cox mixed models quantified the CPAP treatment effect on MACCE (including cardiovascular mortality, myocardial infarction, and stroke) within high-risk OSA and the difference vs low-risk status (primary test).

Cox混合模型量化了持续气道正压（CPAP）治疗对高风险阻塞性睡眠呼吸暂停（OSA）患者主要心血管不良事件（MACCE，包括心血管死亡、心肌梗死和中风）的影响以及与低风险状态的差异（主要测试）。

Secondary analyses examined participants without excessive sleepiness (Epworth <11 points) or without increased blood pressure (systolic/diastolic <140/90 mmHg).

次要分析检查了没有过度嗜睡（Epworth评分<11分）或没有血压升高（收缩压/舒张压<140/90毫米汞柱）的参与者。

Results

In 3549 participants, 16.6% and 16.3% reached the MACCE endpoint with CPAP (n = 1778) and usual care (n = 1771), respectively.

在3549名参与者中，分别有16.6%和16.3%的参与者在接受持续气道正压通气（CPAP，n = 1778）和常规护理（n = 1771）后达到了主要不良脑心血管事件（MACCE）终点。

The CPAP treatment effect was greater in participants with vs without high-risk OSA [interaction hazard ratio(iHR) .69, 95% confidence interval(CI) .50-.95, Pinteraction = .024; Nhigh-risk = 1832].

在高风险睡眠呼吸暂停低通气综合征（OSA）患者中，CPAP治疗效果比无高风险OSA患者更显著[交互作用风险比（iHR）.69，95%置信区间（CI）.50-.95，P交互作用=.024；高风险人数=1832]。

The differential effect was stronger in those without excessive sleepiness (iHR .59, 95% CI .41-.84; Nhigh-risk = 1509), or without increased blood pressure (iHR .54, 95% CI .36-.81; Nhigh-risk = 1244).

在没有过度嗜睡（iHR .59, 95% CI .41-.84; 高风险人数 = 1509）或没有血压升高（iHR .54, 95% CI .36-.81; 高风险人数 = 1244）的人群中，这种差异效应更为显著。

Continuous positive airway pressure benefits in high-risk OSA were observed alongside harm in low-risk OSA.

在高风险OSA患者中观察到持续正压通气（CPAP）的益处，同时在低风险OSA患者中观察到其潜在的害处。

Conclusions

Continuous positive airway pressure preferentially improves cardiovascular outcomes in high-risk OSA, while harm in low-risk OSA may counteract this effect.

持续气道正压通气（CPAP）在高风险的阻塞性睡眠呼吸暂停（OSA）患者中优先改善心血管结局，而在低风险OSA患者中可能产生相反效果，抵消了这种益处。

These findings provide a pathway to identify patients likely to benefit.

这些发现为识别可能受益的患者提供了途径。