{"id":24775,"date":"2023-11-09T04:53:00","date_gmt":"2023-11-08T20:53:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24775"},"modified":"2023-11-09T05:50:18","modified_gmt":"2023-11-08T21:50:18","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9acpap%e6%b2%bb%e7%96%97%e4%be%9d%e4%bb%8e%e6%80%a7%e4%b8%8e%e5%a4%8d%e5%8f%91%e6%80%a7%e5%bf%83%e8%a1%80%e7%ae%a1%e4%ba%8b%e4%bb%b6%e7%9a%84%e9%a3%8e","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24775","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aCPAP\u6cbb\u7597\u4f9d\u4ece\u6027\u4e0e\u590d\u53d1\u6027\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u7684\u98ce\u9669"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

October 3, 2023<\/p>\n\n\n\n

Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis<\/h1>\n\n\n\n

Manuel\u00a0S\u00e1nchez-de-la-Torre,\u00a0Esther\u00a0Gracia-Lavedan,\u00a0Ivan D.\u00a0Benitez,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2023;330(13):1255-1265. doi:10.1001\/jama.2023.17465<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) associated with a decreased risk of cardiovascular adverse events in participants with both OSA and established cardiovascular disease?<\/p>\n\n\n\n

Findings<\/strong>  This systematic review and individual participant data (IPD) meta-analysis of 3 randomized clinical trials including 4186 patients with IPD showed that whereas the IPD meta-analysis based on intention to treat reported no effect of CPAP treatment, the adherent use of CPAP treatment (\u22654 hours\/day) is associated with a reduced recurrence risk of major adverse cardiac or cerebrovascular events (MACCEs) with a significant hazard ratio of 0.69.<\/p>\n\n\n\n

Meaning<\/strong>  Patients with established cardiovascular disease and OSA who used CPAP for 4 or more hours per day had a significantly lower risk of MACCEs than those who used CPAP less than 4 hours per day.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated.<\/p>\n\n\n\n

Objective<\/strong>  To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of adverse cardiovascular events in randomized clinical trials.<\/p>\n\n\n\n

Data Sources<\/strong>  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.<\/p>\n\n\n\n

Study Selection<\/strong>  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.<\/p>\n\n\n\n

Data Extraction and Synthesis<\/strong>  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<\/a>], ISAACC [NCT01335087<\/a>], and RICCADSA [NCT00519597<\/a>]).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  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 (\u22654 hours per day).<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A 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]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  October 3, 2023 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24775"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24775"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24775\/revisions"}],"predecessor-version":[{"id":24776,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24775\/revisions\/24776"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24775"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24775"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24775"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}