R. Doug McEvoy;Nick A. Antic;Emma Heeley;Yuanming Luo;Qiong Ou;希龙 张;Olga Mediano;锐 陈;Luciano F. Drager;Zhihong Liu;Guofang Chen;Baoliang Du;Nigel McArdle;Sutapa Mukherjee;Manjari Tripathi;Laurent Billot;Qiang Li;Geraldo Lorenzi-Filho;Ferran Barbe;Susan Redline;Jiguang Wang;Hisatomi Arima;Bruce Neal;David P. White;Ron R. Grunstein;南山 钟;Craig S. Anderson
Flinders University;Monash University;Southern Adelaide Local Health Network;University of Sydney;Guangzhou Medical College;Guangdong Provincial People's Hospital;Nanjing Medical University;Hospital Universitario de Guadalajara;Soochow University;Universidade de São Paulo;Peking University;Xuzhou Central Hospital;Hejian Municipal People's Hospital;Sir Charles Gairdner Hospital;All India Institute of Medical Sciences;Biomedical Research Institute of Lleida;CIBER - Center for Biomedical Research Network;Harvard University;Shanghai Jiao Tong University;Royal Prince Alfred Hospital
期 刊：New England Journal of Medicine
BACKGROUND: Obstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. METHODS: After a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. RESULTS: Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P = 0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. CONCLUSIONS: Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease.