title: Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches.
abstract: Obstructive sleep apnea (OSA) significantly impacts cardiovascular health, demonstrated by observational investigations showing an independently increased risk of ischemic heart disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, cardiovascular mortality, and all-cause mortality. Positive airway pressure (PAP), a medical therapy for sleep apnea, reverses airway obstruction and may help reduce cardiovascular risk. Prior to planning large phase III randomized controlled trials to test the impact of PAP on cardiovascular outcomes, several gaps in knowledge need to be addressed. This article describes 2 independent studies that worked collaboratively to fill these gaps. The populations, design features, and relative benefits/challenges of the 2 studies (SleepTight and BestAIR) are described. Both studies were encouraged to have multidisciplinary teams with expertise in behavioral interventions to improve PAP compliance. Both studies provide key information that will be useful to the research community in future large-scale, event-driven, randomized trials to evaluate the efficacy and/or effectiveness of strategies to identify and treat significant OSA for decreasing risk of major adverse cardiovascular events in high-risk patients.
authors: Department of Medicine, Yale School of Medicine, New Haven, CT; VA Clinical Epidemiology Research Center, VA Connecticut HCS, West Haven, CT. Electronic address: henry.yaggi@yale.edu.
authors: Henry Klar
authors: HK
authors: Yaggi
authors: Department of Medicine, Beth Israel Deaconess, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors: Murray A
authors: MA
authors: Mittleman
authors: VA Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Medicine, Indiana School of Medicine, Indianapolis, IN; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN.
authors: Dawn M
authors: DM
authors: Bravata
authors: Department of Medicine, Yale School of Medicine, New Haven, CT; VA Clinical Epidemiology Research Center, VA Connecticut HCS, West Haven, CT.
authors: John
authors: J
authors: Concato
authors: Department of Biostatistics, Harvard School of Public Health, Boston, MA.
authors: James
authors: J
authors: Ware
authors: National Heart, Lung, and Blood Institute, NIH, Bethesda, MD.
authors: Catherine M
authors: CM
authors: Stoney
authors: Department of Medicine, Harvard Medical School, Boston, MA; Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors: Susan
authors: S
authors: Redline
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D014943:Global Health; D006801:Humans; D015994:Incidence; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology / Q000628:therapy