The CAD with diabetes phenotype had the highest risk of composite CV events (HR 2.08; 95% CI 1.57-2.76), while CPAP adherence ≥4 hours lowered CV risk in the CeVD with diabetes phenotype (P=0.02).
RCT (n=2,649)
randomised
Does CPAP treatment reduce composite cardiac and stroke outcome events in specific clinical phenotypes of patients with moderate-to-severe OSA and cardiovascular disease?
Identifying specific clinical phenotypes (such as CAD with diabetes or CeVD with diabetes) in patients with OSA and cardiovascular disease can help stratify risk for recurrent events and predict response to CPAP therapy.
Effect estimate: HR 2.08 (95% CI 1.57-2.76)
BACKGROUND: Obstructive sleep apnoea (OSA) is a common comorbidity in patients with cardiovascular (CV) disease. We aimed to identify specific OSA clinical phenotypes relating to risks of serious CV events and response to continuous positive airway pressure (CPAP) treatment. METHODS: Post-hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) study in participants with moderate-to-severe OSA and coronary artery disease (CAD) and/or cerebrovascular disease (CeVD) randomised to CPAP plus usual care or usual care alone. Latent class analysis (LCA) was used to identify OSA clinical phenotypes among 2649 (out of 2687 total) patients with complete data on 19 patient-centered variables, supported by Bayesian information criteria and clinical interpretability. Cox regression models were used to evaluate risks of composite cardiac and stroke outcome events in phenotype groups. Preferential response to CPAP treatment was evaluated using interaction terms as well as the Chi-square test. FINDINGS: LCA identified four OSA clinical phenotypes: CAD alone and with diabetes mellitus (CAD + DM), and CeVD alone and with DM (CeVD + DM), in 39%, 15%, 37% and 9% of participants, respectively. The rates of composite CV events were the highest in CAD + DM phenotype (HR 2.08, 95% CI 1.57-2.76) and for stroke were highest in CeVD + DM phenotype (HR 6.84, 95% CI 3.77-12.42). Adherence to CPAP treatment (nil or < 4 h vs ≥ 4 h in the first two years of the study) was shown to influence the risk of composite CV outcome in the phenotypes (P-interaction = 0.04); CPAP adherent patients of the CeVD + DM phenotype had the lowest risk of CV outcome (P = 0.02). INTERPRETATION: High risk clinical phenotypes were identified in relation to CV events and response to CPAP treatment, which may allow improved targeting of therapies in OSA patients. FUNDING: The National Health and Medical Research Council (NHMRC) of Australia, Fisher & Paykel Healthcare, and ResMed.
Quan et al. (Wed,) conducted a rct in Obstructive sleep apnoea (OSA) with cardiovascular disease (n=2,649). Continuous positive airway pressure (CPAP) plus usual care vs. Usual care alone was evaluated on Composite cardiac and stroke outcome events (HR 2.08, 95% CI 1.57-2.76). The CAD with diabetes phenotype had the highest risk of composite CV events (HR 2.08; 95% CI 1.57-2.76), while CPAP adherence ≥4 hours lowered CV risk in the CeVD with diabetes phenotype (P=0.02).