title: Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial.
abstract: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), many of whom do not report daytime sleepiness. First-line treatment for symptomatic OSA is continuous positive airway pressure (CPAP), but its value in patients without daytime sleepiness is uncertain.
  
  
  
  To determine the effects of CPAP on long-term adverse cardiovascular outcome risk in patients with CAD with nonsleepy OSA.
  
  
  
  This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized CAD and OSA (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating CPAP (n = 122) or no positive airway pressure (n = 122).
  
  
  
  The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive CPAP (18.1% vs. 22.1%; hazard ratio, 0.80; 95% confidence interval, 0.46-1.41; P = 0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used CPAP for ≥4 versus <4 hours per night or did not receive treatment (hazard ratio, 0.29; 95% confidence interval, 0.10-0.86; P = 0.026).
  
  
  
  Routine prescription of CPAP to patients with CAD with nonsleepy OSA did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 00519597).
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|2 Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Yüksel
authors.identifier: 0000-0001-9067-6538
authors.initials: Y
authors.lastname: Peker
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|3 Department of Internal Medicine, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Glantz
authors.affiliation: 4 Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany.
authors.forename: Christine
authors.identifier: 0000-0001-9365-5548
authors.initials: C
authors.lastname: Eulenburg
authors.affiliation: 4 Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany.
authors.forename: Karl
authors.identifier: 0000-0003-2974-3142
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: 5 Center of Prehospital Care of Western Sweden, University College of Borås, Borås, Sweden.|6 Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden; and.
authors.forename: Johan
authors.identifier: 0000-0003-4139-6235
authors.initials: J
authors.lastname: Herlitz
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|7 Department of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
authors.forename: Erik
authors.identifier: 0000-0002-9134-2107
authors.initials: E
authors.lastname: Thunström
mesh_terms: D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009204:Myocardial Revascularization; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000628:therapy*; D013548:Sweden / Q000453:epidemiology
keywords: cardiovascular outcomes; coronary artery disease; obstructive sleep apnea