Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study).

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction. METHODS: An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0-29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE. RESULTS: A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6-64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60-1.83; P = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79-1.96; P = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses. CONCLUSIONS: CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA. CITATION: López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). J Clin Sleep Med. 2022;18(2):553-561.

[Non-invasive ventilation]. / Ventilación no invasiva.

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acute and chronic respiratory failure. Over the last few years, the number of possible applications of NIMV has progressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals and resident physicians currently receive specific training -nonexistent until a few years ago- in this modality. It falls to all of us to push forward the clinical and scientific advances represented by the development of NIMV, by promoting the events that accompany better knowledge of the physiopathological bases of ventilation and of its continuous applications in daily clinical practice and by perfecting the elements required for the correct application of this technique. The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (the physiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony). Through this progression from the complex to the most basic, or from the basics to the most complex, depending on the perspective taken, we aim to provide deeper knowledge of the concepts required to understand the technical functioning of the ventilator, describing its distinct modes and parameters and the abilities that must be developed for the correct indication, use and monitoring of the technique. We provide a final reflection on other forms of respiratory support that can be offered to patients with ventilatory failure.

[Comorbidities in COPD]. / Comorbilidades de la EPOC.

The comorbidities of chronic obstructive pulmonary disease (COPD) consist of all the alterations and disorders associated, for one reason or another, with this disease. These comorbidities may be causal (other diseases also caused by smoking, such as ischemic heart disease or lung cancer), a complication (pulmonary hypertension or heart failure), a concurrence (disorders related to advanced age such as hypertension, diabetes mellitus, depression or osteoarthritis) or an intercurrent process (an acute process, generally time-limited, such as a respiratory infection). Of all these comorbidities, those most frequently associated with COPD are hypertension, diabetes mellitus, infections, cancer and cardiovascular diseases. Comorbidities in COPD not only increase the social repercussions and annual cost of the disease but are also a prognostic factor for mortality in affected individuals. Indeed, in addition to respiratory failure, frequent causes of death in patients with COPD are ischemic heart disease and malignancies. The present article discusses the comorbidities of COPD with the greatest impact due to their frequency or influence on mortality. Although not precisely known, the common mechanism of all these comorbidities could be systemic inflammation and its mediators, which play an important role in the pathogenesis of COPD.