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Longitudinal Analysis of Causes of Mortality in Continuous Positive Airway Pressure-treated Patients at the Population Level.
de Batlle, Jordi; Bertran, Sandra; Turino, Cecilia; Escarrabill, Joan; Dalmases, Mireia; García-Altés, Anna; Sapiña-Beltrán, Esther; Carbonell, Elisenda Martinez; Sánchez-de-la-Torre, Manuel; Barbé, Ferran.
Afiliação
  • de Batlle J; Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida - Fundació Dr. Pifarré), Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Lleida, Spain.
  • Bertran S; Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida - Fundació Dr. Pifarré), Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Lleida, Spain.
  • Turino C; Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida - Fundació Dr. Pifarré), Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Lleida, Spain.
  • Escarrabill J; Chronic Care Program (Hospital Clínic) and Master Plan for Respiratory Diseases (Ministry of Health, Catalonia) and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain.
  • Dalmases M; Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida - Fundació Dr. Pifarré), Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Lleida, Spain.
  • García-Altés A; Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.
  • Sapiña-Beltrán E; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain; and.
  • Carbonell EM; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Sánchez-de-la-Torre M; Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida - Fundació Dr. Pifarré), Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Lleida, Spain.
  • Barbé F; Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.
Ann Am Thorac Soc ; 18(8): 1390-1396, 2021 08.
Article em En | MEDLINE | ID: mdl-33606959
ABSTRACT
Rationale Randomized controlled trials do not support a role for continuous positive airway pressure (CPAP) in preventing major cardiovascular events or mortality in patients with obstructive sleep apnea (OSA). However, these trials' setting does not apply to most CPAP-treated patients.

Objectives:

We aimed to assess the effect of CPAP on mortality in real-world patients.

Methods:

We performed a population-based longitudinal observational study including all patients with OSA prescribed CPAP during 2011 in Catalonia, Spain, and non-OSA control subjects matched (12) by sex, 5-year age group, and region who were followed from 2011 to 2016.

Results:

A total of 9,317 CPAP-treated patients with OSA and 18,370 control subjects without OSA were included (median age, 67 [57-72] years; 74% male). During a median follow-up of 5.5 years, 2,301 deaths were recorded. After adjustment by a composite of diagnosed comorbidities and previous use of healthcare resources, CPAP-treated patients showed a lower risk of death than control subjects (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.61-0.74), with the association not being statistically significant in women. Cancer-related deaths were the main drivers of this association (men HR, 0.44; 95% CI, 0.36-0.54; women HR, 0.44; 95% CI, 0.28-0.68). No significant associations were found for cardiovascular-related deaths. CPAP-treated women had an increased risk of respiratory-related death (HR, 2.41; 95% CI, 1.37-4.23).

Conclusions:

CPAP-treated patients had a lower mortality rate than control subjects. This relationship was driven by cancer-related, but not cardiovascular-related, deaths. Results suggest a role for sex when prescribing CPAP, especially considering respiratory-related deaths, and foster a debate on the relationship between OSA and cardiovascular outcomes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apneia Obstrutiva do Sono / Pressão Positiva Contínua nas Vias Aéreas Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Ann Am Thorac Soc Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Espanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apneia Obstrutiva do Sono / Pressão Positiva Contínua nas Vias Aéreas Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Ann Am Thorac Soc Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Espanha