The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial
Abstract Background Most patients with comorbid sleep apnea (OSA), cardiovascular (CV) disease, and/or cerebrovascular (CeV) disease simultaneously take medications. Whether OSA and continuous positive airway pressure (CPAP) interact with CV/CeV medications remains unknown. This study aimed to deter...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-03-01
|
| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12890-022-01879-2 |
| _version_ | 1828317242126761984 |
|---|---|
| author | Miaochan Lao Yilu Cheng Xinglin Gao Qiong Ou |
| author_facet | Miaochan Lao Yilu Cheng Xinglin Gao Qiong Ou |
| author_sort | Miaochan Lao |
| collection | DOAJ |
| description | Abstract Background Most patients with comorbid sleep apnea (OSA), cardiovascular (CV) disease, and/or cerebrovascular (CeV) disease simultaneously take medications. Whether OSA and continuous positive airway pressure (CPAP) interact with CV/CeV medications remains unknown. This study aimed to determine the interaction among OSA, CPAP, and CV/CeV medications; the effects of medications on major adverse cardiac and cerebrovascular events, and survival in patients with comorbid OSA and CV/CeV. Methods This was a post hoc analysis of the data from one center of the Sleep Apnea Cardiovascular Endpoints Study. Participants (aged 45–75 years) with comorbid OSA and CV/CeV were randomized to receive usual care with or without CPAP from December 2008 to November 2013. The primary endpoint was death and the secondary endpoint was a composite of death, myocardial infarction, stroke, hospitalization for unstable angina, heart failure, and transient ischemic attack. Results In total, 131 patients were analyzed. Sixty-three were in the CPAP group and 68 were in the usual care group, 41 had good adherence to CPAP (65.1%), and the median follow-up time was 43.0 (35.0, 54.0) months. In Cox regression analysis, ACE inhibitors and nitrates were independent factors for decreased survival in patients with comorbid OSA and CV/CeV (chi-square = 22.932, P = 0.003; ACE inhibitors: OR 7.241, P = 0.048, 95% CI 1.016–51.628; nitrates: OR 18.012, P = 0.011, 95% CI 1.923–168.750). ACE inhibitors increased mortality and secondary endpoints in the CPAP group (chi-square = 4.134, P = 0.042) but not in patients with good CPAP adherence. Clopidogrel and nitrates decreased survival in usual care group (clopidogrel: chi-square = 5.312, P = 0.021; nitrates: chi-square = 6.417, P = 0.011), but not in CPAP group. Conclusions OSA may predispose patients with CV/CeV and CV/CeV medications to a negative effect. CPAP treatment may neutralize the negative effects of OSA by relieving chronic intermittent hypoxia. Trial registration ClinicalTrials.gov (NCT00738179, first registration date: 20/08/2008). |
| first_indexed | 2024-04-13T17:25:21Z |
| format | Article |
| id | doaj.art-d9548e9646e341fab851ea1d3d3cdfbd |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-13T17:25:21Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-d9548e9646e341fab851ea1d3d3cdfbd2022-12-22T02:37:48ZengBMCBMC Pulmonary Medicine1471-24662022-03-012211810.1186/s12890-022-01879-2The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trialMiaochan Lao0Yilu Cheng1Xinglin Gao2Qiong Ou3Department of Sleep Center, Department of Geriatric Respiratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics InstituteDepartment of Sleep Center, Department of Geriatric Respiratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics InstituteGeriatric Respiratory Department I, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics InstituteDepartment of Sleep Center, Department of Geriatric Respiratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics InstituteAbstract Background Most patients with comorbid sleep apnea (OSA), cardiovascular (CV) disease, and/or cerebrovascular (CeV) disease simultaneously take medications. Whether OSA and continuous positive airway pressure (CPAP) interact with CV/CeV medications remains unknown. This study aimed to determine the interaction among OSA, CPAP, and CV/CeV medications; the effects of medications on major adverse cardiac and cerebrovascular events, and survival in patients with comorbid OSA and CV/CeV. Methods This was a post hoc analysis of the data from one center of the Sleep Apnea Cardiovascular Endpoints Study. Participants (aged 45–75 years) with comorbid OSA and CV/CeV were randomized to receive usual care with or without CPAP from December 2008 to November 2013. The primary endpoint was death and the secondary endpoint was a composite of death, myocardial infarction, stroke, hospitalization for unstable angina, heart failure, and transient ischemic attack. Results In total, 131 patients were analyzed. Sixty-three were in the CPAP group and 68 were in the usual care group, 41 had good adherence to CPAP (65.1%), and the median follow-up time was 43.0 (35.0, 54.0) months. In Cox regression analysis, ACE inhibitors and nitrates were independent factors for decreased survival in patients with comorbid OSA and CV/CeV (chi-square = 22.932, P = 0.003; ACE inhibitors: OR 7.241, P = 0.048, 95% CI 1.016–51.628; nitrates: OR 18.012, P = 0.011, 95% CI 1.923–168.750). ACE inhibitors increased mortality and secondary endpoints in the CPAP group (chi-square = 4.134, P = 0.042) but not in patients with good CPAP adherence. Clopidogrel and nitrates decreased survival in usual care group (clopidogrel: chi-square = 5.312, P = 0.021; nitrates: chi-square = 6.417, P = 0.011), but not in CPAP group. Conclusions OSA may predispose patients with CV/CeV and CV/CeV medications to a negative effect. CPAP treatment may neutralize the negative effects of OSA by relieving chronic intermittent hypoxia. Trial registration ClinicalTrials.gov (NCT00738179, first registration date: 20/08/2008).https://doi.org/10.1186/s12890-022-01879-2Obstructive sleep apneaCardiovascular diseaseCerebrovascular diseaseMedicationPrognosis |
| spellingShingle | Miaochan Lao Yilu Cheng Xinglin Gao Qiong Ou The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial BMC Pulmonary Medicine Obstructive sleep apnea Cardiovascular disease Cerebrovascular disease Medication Prognosis |
| title | The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial |
| title_full | The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial |
| title_fullStr | The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial |
| title_full_unstemmed | The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial |
| title_short | The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial |
| title_sort | interaction among osa cpap and medications in patients with comorbid osa and cardiovascular cerebrovascular disease a randomized controlled trial |
| topic | Obstructive sleep apnea Cardiovascular disease Cerebrovascular disease Medication Prognosis |
| url | https://doi.org/10.1186/s12890-022-01879-2 |
| work_keys_str_mv | AT miaochanlao theinteractionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT yilucheng theinteractionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT xinglingao theinteractionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT qiongou theinteractionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT miaochanlao interactionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT yilucheng interactionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT xinglingao interactionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial AT qiongou interactionamongosacpapandmedicationsinpatientswithcomorbidosaandcardiovascularcerebrovasculardiseasearandomizedcontrolledtrial |