000165571 001__ 165571
000165571 005__ 20260112132216.0
000165571 0247_ $$2doi$$a10.1183/13993003.00519-2025
000165571 0248_ $$2sideral$$a146739
000165571 037__ $$aART-2025-146739
000165571 041__ $$aeng
000165571 100__ $$aDivo, Miguel J.
000165571 245__ $$aMajor cardiovascular event or death risk in obstructive sleep apnoea and the effect of positive airway pressure
000165571 260__ $$c2025
000165571 5060_ $$aAccess copy available to the general public$$fUnrestricted
000165571 5203_ $$aBackground: Evidence regarding the efficacy of positive airway pressure (PAP) therapy in reducing the risk of non-fatal major cardiovascular events (NF-MACE) and mortality in patients with obstructive sleep apnoea (OSA) remains controversial. This study aims to quantify the impact of PAP therapy on these risks and develop a predictive risk estimator.
Methods: We conducted a multicentre, observational, prospective study involving 5358 individuals diagnosed with OSA, with a median (interquartile range (IQR)) follow-up of 14 (10–15) years. We derived and validated a risk estimator of NF-MACE (including myocardial infarction, stroke, revascularisation procedures and congestive heart failure) and all-cause mortality, incorporating PAP adherence alongside clinical and sleep-related data.
Results: The cohort had mean±sd age 55±11 years, body mass index 32.0±5.4 kg·m−2 and apnoea–hypopnoea index (AHI) 35±22 events·h−1; 26% were females and 1467 (37%) were PAP adherent. Over the follow-up period, 754 participants experienced NF-MACE, while 858 deaths were recorded. Significant predictors included prior cardiovascular events, non-high-density lipoprotein cholesterol ≥200 mg·dL−1, COPD diagnosis, AHI >30 events·h−1 and age >60 years. PAP adherence was protective (OR 0.46, 95% CI 0.38–0.56) and the absolute risk reduction varied depending on the baseline risk (median (IQR) 16% (12–18%)). The risk estimator yielded an area under the receiver operating characteristic curve of 0.75 and a Brier score of 0.17, with 64% sensitivity and 75% specificity.
Conclusions: The cohort had mean±sd age 55±11 years, body mass index 32.0±5.4 kg·m−2 and apnoea–hypopnoea index (AHI) 35±22 events·h−1; 26% were females and 1467 (37%) were PAP adherent. Over the follow-up period, 754 participants experienced NF-MACE, while 858 deaths were recorded. Significant predictors included prior cardiovascular events, non-high-density lipoprotein cholesterol ≥200 mg·dL−1, COPD diagnosis, AHI >30 events·h−1 and age >60 years. PAP adherence was protective (OR 0.46, 95% CI 0.38–0.56) and the absolute risk reduction varied depending on the baseline risk (median (IQR) 16% (12–18%)). The risk estimator yielded an area under the receiver operating characteristic curve of 0.75 and a Brier score of 0.17, with 64% sensitivity and 75% specificity.
000165571 540__ $$9info:eu-repo/semantics/embargoedAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/
000165571 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000165571 700__ $$aMartinez-Garcia, Miguel A.
000165571 700__ $$aGonzalez, Monica
000165571 700__ $$aCampos-Rodriguez, Francisco
000165571 700__ $$aLloberes, Patricia
000165571 700__ $$0(orcid)0000-0003-0777-3850$$aMarin-Oto, Marta$$uUniversidad de Zaragoza
000165571 700__ $$aForner, Marta
000165571 700__ $$0(orcid)0000-0002-5228-248X$$aSanz-Rubio, David
000165571 700__ $$aNieto, David
000165571 700__ $$aCelli, Bartolome R.
000165571 700__ $$0(orcid)0000-0001-9096-2294$$aMarin, Jose M.$$uUniversidad de Zaragoza
000165571 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000165571 773__ $$g66, 5 (2025), 2500519$$pEur. respir. j.$$tEuropean respiratory journal$$x0903-1936
000165571 8564_ $$s2160313$$uhttps://zaguan.unizar.es/record/165571/files/texto_completo.pdf$$yPostprint$$zinfo:eu-repo/date/embargoEnd/2026-11-25
000165571 8564_ $$s1482476$$uhttps://zaguan.unizar.es/record/165571/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint$$zinfo:eu-repo/date/embargoEnd/2026-11-25
000165571 909CO $$ooai:zaguan.unizar.es:165571$$particulos$$pdriver
000165571 951__ $$a2026-01-12-11:10:19
000165571 980__ $$aARTICLE