Effect of obstructive sleep apnoea and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial
This study is registered with Clinicaltrials.gov, NCT01335087 and is now closed.FindingsBetween April 25, 2011, and Feb 2, 2018, a total of 2834 patients with ACS had respiratory polygraphy, of whom 2551 (90·01%) were recruited. 1264 (49·55%) patients had OSA and were randomly assigned to the CPAP group (n=633) or the UC group (n=631). 1287 (50·45%) patients did not have OSA, of whom 603 (46·85%) were randomly assigned to the reference group. Patients were followed up for a median of 3·35 years (IQR 1·50–5·31). The prevalence of cardiovascular events was similar in the CPAP and UC groups (98 events [16%] vs 108 events [17%]; hazard ratio [HR] 0·89 [95% CI 0·68–1·17]; p=0·40) during follow-up. Mean time of adherence to CPAP treatment was 2·78 h/night (SD 2·73). The prevalence of cardiovascular events was similar between patients in the reference group (90 [15%] events) and those in the UC group (102 (17%) events) during follow-up (1·01 [0·76–1·35]; p=0·93). The prevalence of cardiovascular events seem not to be related to CPAP compliance or OSA severity. 464 (74%) of 629 patients in the CPAP group had 1538 serious adverse events and 406 (65%) of 626 patients in the UC group had 1764 serious adverse events.InterpretationAmong non-sleepy patients with ACS, the presence of OSA was not associated with an increased prevalence of cardiovascular eve...
This study aimed to analyse the characteristics and trend of yoga-related emergency department (ED) presentations from July 2009 to June 2016 in Victoria, Australia.Methods: The Victorian Emergency Minimum Dataset (VEMD) was used to collect the de-identified data. The data were first analysed using descriptive statistics and Spearman`s correlation. Further injury trend was analysed by calculating percentage change of the number of yoga-related injuries during the seven-year study period. Results: There were 118 yoga-related injury cases that significantly (p
ConclusionAmong patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.Graphical Abstract
In 2015, a multi-national randomized controlled phase IV clinical trial of adaptive servo-ventilation for the management of heart failure with central sleep apnea was halted in progress because more patients in the study group were dying than in the control group. One year later, another large clinical trial reported results on the effectiveness of continuous positive airway pressure (CPAP) in preventing sudden death and other cardiovascular events such as heart attack and stroke in patients with pre-existing vascular disease as well as obstructive sleep apnea.
Conclusions: SAVE provides the first definitive randomised controlled trial evidence on the effectiveness of CPAP therapy on future CV events in patients with CV disease and co-occurring OSA.
Patients with obstructive sleep apnea (OSA) have an increased prevalence of systemic and pulmonary hypertension, left ventricular (LV) hypertrophy, LV systolic and diastolic dysfunction, and congestive heart failure, increased platelet aggregability, and increased susceptibility to thrombotic and embolic cardiac and cerebrovascular events. Patients with OSA have an increased prevalence of coronary artery disease, myocardial infarction, nocturnal angina, and myocardial ischemia, arrhythmias, and sudden cardiac death. Patients with OSA also have an increased prevalence of stroke. Treatment of OSA with continuous positive air...