Association of Hypoxic Burden With Cardiovascular Events: A Risk Stratification Analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea Cohort
Abstract
BACKGROUND: The apnea-hypopnea index (AHI), the standard measure of OSA, has limitations in reflecting disease severity.
RESEARCH QUESTION: Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI of ≥ 30 events/h?
STUDY DESIGN AND METHODS: This secondary analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea observational cohort included 368 adults with OSA (AHI ≥ 15 events/h) with (n = 155) and without (n = 244) excessive daytime sleepiness (EDS), defined as an Epworth Sleepiness Scale score of ≥ 10. HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time. Patients were classified as having high or low HB based on the median (60.7%min/h). The primary outcome was the incident of the first MACCE. Cox proportional hazard models assessed associations in the full cohort and by CPAP allocation and adherence (nonadherent or no positive airway pressure [PAP] group, n = 262; adherent [adjusted PAP use ≥ 4 h/night for all nights at 1-year follow-up], n = 106). In an exploratory analysis, participants were grouped into 4 categories based on median AHI and HB (low and low, low and high, high and low, and high and high, respectively).
RESULTS: Over a median follow-up of 4.7 years, high HB was associated with MACCEs (adjusted hazard ratio, 1.87; 95% CI, 1.17-2.98; P = .009), particularly among untreated or nonadherent…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 368 participants or records.
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