The SAVE Trial: Has the Importance of CPAP for Preventing Cardiovascular Events been Discounted?

BaHammam, Ahmed S.; Pandi-Perumal, Seithikurippu R.; Spence, D. Warren; Moscovitch, Adam; Streiner, David L.

doi:10.1007/s41782-017-0003-z

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Despite the fact that there is a strong connection between CVD and OSA, randomized clinical trials are yet to show that treating OSA improves cardiovascular outcomes [6]. There is very limited data from randomized trials, which have been limited in number and design [7].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of CPAP Therapy in Relation to Cardiovascular Outcome in a Cohort of Romanian Obstructive Sleep Apnea Patients

Chetan

Maierean

Gergely

et al. 2021

JPM

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Background: Despite efforts at treatment, obstructive sleep apnea (OSA) remains a major health problem, especially with increasing evidence showing an association with cardiovascular morbidity and mortality. The treatment of choice for OSA patients is Continuous Positive Airway Pressure (CPAP), which has been proven in randomized controlled trials to be an effective therapy for this condition. The impact of CPAP on the cardiovascular pathology associated with OSA remains, however, unclear. Although the effect of CPAP has been previously studied in relation to cardiovascular outcome, follow-up of the treatment impact on cardiovascular risk factors at one year of therapy is lacking in a Romanian population. Thus, we aimed to evaluate the one-year effect of CPAP therapy on lipid profile, inflammatory state, blood pressure and cardiac function, assessed by echocardiography, on a cohort of Romanian OSA patients. Methods: We enrolled 163 participants and recorded their baseline demographic and clinical characteristics with a follow-up after 12 months. Inflammatory and cardiovascular risk factors were assessed at baseline and follow up. Results: Our results show that CPAP therapy leads to attenuation of cardiovascular risk factors including echocardiographic parameters, while having no effect on inflammatory markers. Conclusion: Treatment of OSA with CPAP proved to have beneficial effects on some of the cardiovascular risk factors while others remained unchanged, raising new questions for research into the treatment and management of OSA patients.

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Section: Introductionmentioning

confidence: 99%

A Prospective Study of CPAP Therapy in Relation to Cardiovascular Outcome in a Cohort of Romanian Obstructive Sleep Apnea Patients

Chetan

Maierean

Gergely

et al. 2021

JPM

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“…Trials for cardiovascular outcomes in patients with OSA after continuous positive airway pressure (CPAP) use are equivocal and discouraging [23,24]. However, analyses of trials show that these trials are flawed due to patient selection, diagnostics and suboptimal treatment [25]. The suboptimal treatment is illustrated by the subanalysis of the sleep apnoea cardiovascular endpoints (SAVE) trial, wherein 561 patients with nightly CPAP adherence more than 4 h/night had a significantly lower risk of cerebrovascular events [25].…”

Section: Rapid Eye Movement-obstructive Sleep Apnoea and Cardiovascul...mentioning

confidence: 99%

“…However, analyses of trials show that these trials are flawed due to patient selection, diagnostics and suboptimal treatment [25]. The suboptimal treatment is illustrated by the subanalysis of the sleep apnoea cardiovascular endpoints (SAVE) trial, wherein 561 patients with nightly CPAP adherence more than 4 h/night had a significantly lower risk of cerebrovascular events [25]. Similarly, on-treatment analysis of the Randomized Intervention with CPAP in coronary artery disease and Sleep Apnea (RIC-CADSA) trial showed a significant risk reduction in those who used CPAP for more than 4 h vs. less than 4 h/day or did not receive treatment (adjusted hazard ratio, 0.17; 95% CI, 0.03-0.81; P ¼ 0.03) [23].…”

Section: Rapid Eye Movement-obstructive Sleep Apnoea and Cardiovascul...mentioning

confidence: 99%

Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach

Pirzada

BaHammam

2021

Current Opinion in Pulmonary Medicine

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Purpose of reviewRapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls.Recent findingsCurrent evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes.SummaryPatients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.

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Role of Sleep and Sleep Disorders in Cardiometabolic Risk: a Review and Update

Qasrawi,

BaHammam

2024

Curr Sleep Medicine Rep

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The SAVE Trial: Has the Importance of CPAP for Preventing Cardiovascular Events been Discounted?

Cited by 5 publications

References 12 publications

A Prospective Study of CPAP Therapy in Relation to Cardiovascular Outcome in a Cohort of Romanian Obstructive Sleep Apnea Patients

A Prospective Study of CPAP Therapy in Relation to Cardiovascular Outcome in a Cohort of Romanian Obstructive Sleep Apnea Patients

Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach

Role of Sleep and Sleep Disorders in Cardiometabolic Risk: a Review and Update

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