Cardiovascular Mortality in Obstructive Sleep Apnea in the Elderly: Role of Long-Term Continuous Positive Airway Pressure Treatment: A Prospective Observational Study
Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly. To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP)...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2012-11, Vol.186 (9), p.909-916 |
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| creator | MARTINEZ-GARCIA, Miguel-Angel CAMPOS-RODRIGUEZ, Francisco CATALAN-SERRA, Pablo SOLER-CATALUNA, Juan-José ALMEIDA-GONZALEZ, Carmen DE LA CRUZ MORON, Ines DURAN-CANTOLLA, Joaquin MONTSERRAT, Josep-Maria |
| description | Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly.
To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly.
Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality.
A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group.
Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk. |
| doi_str_mv | 10.1164/rccm.201203-0448OC |
| format | Article |
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To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly.
Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality.
A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group.
Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201203-0448OC</identifier><identifier>PMID: 22983957</identifier><language>eng</language><publisher>New York, NY: American Thoracic Society</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood pressure ; Cardiac arrhythmia ; Cardiovascular disease ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - prevention & control ; Cause of Death ; Continuous positive airway pressure ; Continuous Positive Airway Pressure - statistics & numerical data ; Emergency and intensive respiratory care ; Female ; Heart failure ; Humans ; Hypertension ; Intensive care medicine ; Ischemia ; Kaplan-Meier Estimate ; Long-Term Care ; Male ; Medical sciences ; Mortality ; Observational studies ; Older people ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Sleep apnea ; Sleep Apnea, Obstructive - complications ; Sleep Apnea, Obstructive - mortality ; Sleep Apnea, Obstructive - therapy ; Spain - epidemiology ; Survival analysis ; Thoracic surgery</subject><ispartof>American journal of respiratory and critical care medicine, 2012-11, Vol.186 (9), p.909-916</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Thoracic Society Nov 1, 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c394t-6ecf6c95d3cc4a6e3c1bececb3d0cacb4627f505b1ba485ca36b324abec0a0593</citedby><cites>FETCH-LOGICAL-c394t-6ecf6c95d3cc4a6e3c1bececb3d0cacb4627f505b1ba485ca36b324abec0a0593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,4011,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26598427$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22983957$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MARTINEZ-GARCIA, Miguel-Angel</creatorcontrib><creatorcontrib>CAMPOS-RODRIGUEZ, Francisco</creatorcontrib><creatorcontrib>CATALAN-SERRA, Pablo</creatorcontrib><creatorcontrib>SOLER-CATALUNA, Juan-José</creatorcontrib><creatorcontrib>ALMEIDA-GONZALEZ, Carmen</creatorcontrib><creatorcontrib>DE LA CRUZ MORON, Ines</creatorcontrib><creatorcontrib>DURAN-CANTOLLA, Joaquin</creatorcontrib><creatorcontrib>MONTSERRAT, Josep-Maria</creatorcontrib><title>Cardiovascular Mortality in Obstructive Sleep Apnea in the Elderly: Role of Long-Term Continuous Positive Airway Pressure Treatment: A Prospective Observational Study</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly.
To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly.
Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality.
A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group.
Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood pressure</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cause of Death</subject><subject>Continuous positive airway pressure</subject><subject>Continuous Positive Airway Pressure - statistics & numerical data</subject><subject>Emergency and intensive respiratory care</subject><subject>Female</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Intensive care medicine</subject><subject>Ischemia</subject><subject>Kaplan-Meier Estimate</subject><subject>Long-Term Care</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Older people</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - complications</subject><subject>Sleep Apnea, Obstructive - mortality</subject><subject>Sleep Apnea, Obstructive - therapy</subject><subject>Spain - epidemiology</subject><subject>Survival analysis</subject><subject>Thoracic surgery</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkV2L1DAUhoso7rr6B7yQgAjedM1XO-3eDWX9gJFZ3BG8K6fpqWZJm26SjvQP-TtN7ajgjVcJyXPec877JslzRi8Zy-Ubp1R_ySnjVKRUymJfPUjOWSayVJYb-jDe6UakUpZfzpIn3t_RiBaMPk7OOC8LUWab8-RHBa7V9gheTQYc-WhdAKPDTPRA9o0PblJBH5HcGsSRbMcBYfkK35Bcmxadma_IJ2uQ2I7s7PA1PaDrSWWHoIfJTp7cWK9_KWy1-w4zuXHo_eSQHBxC6HEIV2QbX60fcW0V26I7QtB2AENuw9TOT5NHHRiPz07nRfL57fWhep_u9u8-VNtdqkQpQ5qj6nJVZq1QSkKOQrEGFapGtFSBamTON11Gs4Y1IItMgcgbwSVEiALNSnGRvF51R2fvJ_Sh7rVXaAwMGJepGeciWhj9_T_KeJ4zIfiCvvwHvbOTi8stVFZSGTERKb5SKnrhHXb16HQPbq4ZrZfA6yXweg28XgOPRS9O0lPTY_un5HfCEXh1AmLEYDoHg9L-L5dnZSHjjD8BbFS3zw</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>MARTINEZ-GARCIA, Miguel-Angel</creator><creator>CAMPOS-RODRIGUEZ, Francisco</creator><creator>CATALAN-SERRA, Pablo</creator><creator>SOLER-CATALUNA, Juan-José</creator><creator>ALMEIDA-GONZALEZ, Carmen</creator><creator>DE LA CRUZ MORON, Ines</creator><creator>DURAN-CANTOLLA, Joaquin</creator><creator>MONTSERRAT, Josep-Maria</creator><general>American Thoracic Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope></search><sort><creationdate>20121101</creationdate><title>Cardiovascular Mortality in Obstructive Sleep Apnea in the Elderly: Role of Long-Term Continuous Positive Airway Pressure Treatment: A Prospective Observational Study</title><author>MARTINEZ-GARCIA, Miguel-Angel ; CAMPOS-RODRIGUEZ, Francisco ; CATALAN-SERRA, Pablo ; SOLER-CATALUNA, Juan-José ; ALMEIDA-GONZALEZ, Carmen ; DE LA CRUZ MORON, Ines ; DURAN-CANTOLLA, Joaquin ; MONTSERRAT, Josep-Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c394t-6ecf6c95d3cc4a6e3c1bececb3d0cacb4627f505b1ba485ca36b324abec0a0593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood pressure</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cause of Death</topic><topic>Continuous positive airway pressure</topic><topic>Continuous Positive Airway Pressure - statistics & numerical data</topic><topic>Emergency and intensive respiratory care</topic><topic>Female</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Intensive care medicine</topic><topic>Ischemia</topic><topic>Kaplan-Meier Estimate</topic><topic>Long-Term Care</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Older people</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Sleep apnea</topic><topic>Sleep Apnea, Obstructive - complications</topic><topic>Sleep Apnea, Obstructive - mortality</topic><topic>Sleep Apnea, Obstructive - therapy</topic><topic>Spain - epidemiology</topic><topic>Survival analysis</topic><topic>Thoracic surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MARTINEZ-GARCIA, Miguel-Angel</creatorcontrib><creatorcontrib>CAMPOS-RODRIGUEZ, Francisco</creatorcontrib><creatorcontrib>CATALAN-SERRA, Pablo</creatorcontrib><creatorcontrib>SOLER-CATALUNA, Juan-José</creatorcontrib><creatorcontrib>ALMEIDA-GONZALEZ, Carmen</creatorcontrib><creatorcontrib>DE LA CRUZ MORON, Ines</creatorcontrib><creatorcontrib>DURAN-CANTOLLA, Joaquin</creatorcontrib><creatorcontrib>MONTSERRAT, Josep-Maria</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MARTINEZ-GARCIA, Miguel-Angel</au><au>CAMPOS-RODRIGUEZ, Francisco</au><au>CATALAN-SERRA, Pablo</au><au>SOLER-CATALUNA, Juan-José</au><au>ALMEIDA-GONZALEZ, Carmen</au><au>DE LA CRUZ MORON, Ines</au><au>DURAN-CANTOLLA, Joaquin</au><au>MONTSERRAT, Josep-Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiovascular Mortality in Obstructive Sleep Apnea in the Elderly: Role of Long-Term Continuous Positive Airway Pressure Treatment: A Prospective Observational Study</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>186</volume><issue>9</issue><spage>909</spage><epage>916</epage><pages>909-916</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly.
To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly.
Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality.
A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group.
Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk.</abstract><cop>New York, NY</cop><pub>American Thoracic Society</pub><pmid>22983957</pmid><doi>10.1164/rccm.201203-0448OC</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2012-11, Vol.186 (9), p.909-916 |
| issn | 1073-449X 1535-4970 |
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| source | MEDLINE; Journals@Ovid Complete; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood pressure Cardiac arrhythmia Cardiovascular disease Cardiovascular Diseases - etiology Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Cause of Death Continuous positive airway pressure Continuous Positive Airway Pressure - statistics & numerical data Emergency and intensive respiratory care Female Heart failure Humans Hypertension Intensive care medicine Ischemia Kaplan-Meier Estimate Long-Term Care Male Medical sciences Mortality Observational studies Older people Proportional Hazards Models Prospective Studies Risk Factors Sleep apnea Sleep Apnea, Obstructive - complications Sleep Apnea, Obstructive - mortality Sleep Apnea, Obstructive - therapy Spain - epidemiology Survival analysis Thoracic surgery |
| title | Cardiovascular Mortality in Obstructive Sleep Apnea in the Elderly: Role of Long-Term Continuous Positive Airway Pressure Treatment: A Prospective Observational Study |
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