Physiological traits and adherence to sleep apnea therapy in individuals with coronary artery disease
(2021) In American Journal of Respiratory and Critical Care Medicine 204(6). p.703-712- Abstract
Rationale: Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but despite interventions addressing established adherence determinants, CPAP use remains poor. Objectives: To determine whether physiological traits that cause OSA are associated with long-term CPAP adherence in patients with CAD. Methods: Participants in the RICCADSA (Randomized Intervention with CPAP in CAD and OSA) trial with objective CPAP adherence (h/night) over 2 years and analyzable raw polysomnography data were included (N = 249). The physiological traits-loop gain, arousal threshold (ArTH), pharyngeal collapsibility... (More)
Rationale: Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but despite interventions addressing established adherence determinants, CPAP use remains poor. Objectives: To determine whether physiological traits that cause OSA are associated with long-term CPAP adherence in patients with CAD. Methods: Participants in the RICCADSA (Randomized Intervention with CPAP in CAD and OSA) trial with objective CPAP adherence (h/night) over 2 years and analyzable raw polysomnography data were included (N = 249). The physiological traits-loop gain, arousal threshold (ArTH), pharyngeal collapsibility (V_passive), and pharyngeal muscle compensation (V_comp)-were measured by using polysomnography. Linear mixed models were used to assess the relationship between the traits and adherence. We also compared actual CPAP adherence between those with physiologically predicted “poor” adherence (lowest quartile of predicted adherence) and those with physiologically predicted “good” adherence (all others). Measurements and Main Results: The median (interquartile range) CPAP use declined from 3.2 (1.0-5.8) h/night to 3.0 (0.0-5.6) h/night over 24 months (P, 0.001). In analyses adjusted for demographics, anthropometrics, OSA characteristics, and clinical comorbidities, a lower ArTH was associated with worse CPAP adherence (0.7 h/SD of the ArTH; P = 0.021). Both high and low V_comp were associated with lower adherence (P = 0.008). Those with predicted poor adherence exhibited markedly lower CPAP use than those with predicted good adherence for up to 2 years of follow-up (group differences of 2.0-3.2 h/night; P, 0.003 for all). Conclusions: A low ArTH, as well as a very low and high V_comp, are associated with worse long-term CPAP adherence in patients with CAD and OSA. Physiological traits-alongside established determinants-may help predict and improve CPAP adherence.
(Less)
- author
- Zinchuk, Andrey V. ; Chu, Jen Hwa ; Liang, Jiasheng ; Celik, Yeliz ; de Beeck, Sara Op ; Redeker, Nancy S. ; Wellman, Andrew ; Yaggi, H. Klar ; Peker, Yüksel LU and Sands, Scott A.
- organization
- publishing date
- 2021-09-15
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adherence, Arousal threshold, Coronary artery disease, Obstructive sleep apnea, Physiologic traits
- in
- American Journal of Respiratory and Critical Care Medicine
- volume
- 204
- issue
- 6
- pages
- 10 pages
- publisher
- American Thoracic Society
- external identifiers
-
- scopus:85115643152
- pmid:34156917
- ISSN
- 1073-449X
- DOI
- 10.1164/rccm.202101-0055OC
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2021 American Thoracic Society. All rights reserved.
- id
- 8b6ae0a5-3f25-4188-a1cc-d3061cdaff6d
- date added to LUP
- 2021-10-14 13:00:41
- date last changed
- 2024-06-15 18:08:53
@article{8b6ae0a5-3f25-4188-a1cc-d3061cdaff6d,
abstract = {{<p>Rationale: Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but despite interventions addressing established adherence determinants, CPAP use remains poor. Objectives: To determine whether physiological traits that cause OSA are associated with long-term CPAP adherence in patients with CAD. Methods: Participants in the RICCADSA (Randomized Intervention with CPAP in CAD and OSA) trial with objective CPAP adherence (h/night) over 2 years and analyzable raw polysomnography data were included (N = 249). The physiological traits-loop gain, arousal threshold (ArTH), pharyngeal collapsibility (V<sup>_</sup>passive), and pharyngeal muscle compensation (V<sup>_</sup>comp)-were measured by using polysomnography. Linear mixed models were used to assess the relationship between the traits and adherence. We also compared actual CPAP adherence between those with physiologically predicted “poor” adherence (lowest quartile of predicted adherence) and those with physiologically predicted “good” adherence (all others). Measurements and Main Results: The median (interquartile range) CPAP use declined from 3.2 (1.0-5.8) h/night to 3.0 (0.0-5.6) h/night over 24 months (P, 0.001). In analyses adjusted for demographics, anthropometrics, OSA characteristics, and clinical comorbidities, a lower ArTH was associated with worse CPAP adherence (0.7 h/SD of the ArTH; P = 0.021). Both high and low V<sup>_</sup>comp were associated with lower adherence (P = 0.008). Those with predicted poor adherence exhibited markedly lower CPAP use than those with predicted good adherence for up to 2 years of follow-up (group differences of 2.0-3.2 h/night; P, 0.003 for all). Conclusions: A low ArTH, as well as a very low and high V<sup>_</sup>comp, are associated with worse long-term CPAP adherence in patients with CAD and OSA. Physiological traits-alongside established determinants-may help predict and improve CPAP adherence.</p>}},
author = {{Zinchuk, Andrey V. and Chu, Jen Hwa and Liang, Jiasheng and Celik, Yeliz and de Beeck, Sara Op and Redeker, Nancy S. and Wellman, Andrew and Yaggi, H. Klar and Peker, Yüksel and Sands, Scott A.}},
issn = {{1073-449X}},
keywords = {{Adherence; Arousal threshold; Coronary artery disease; Obstructive sleep apnea; Physiologic traits}},
language = {{eng}},
month = {{09}},
number = {{6}},
pages = {{703--712}},
publisher = {{American Thoracic Society}},
series = {{American Journal of Respiratory and Critical Care Medicine}},
title = {{Physiological traits and adherence to sleep apnea therapy in individuals with coronary artery disease}},
url = {{http://dx.doi.org/10.1164/rccm.202101-0055OC}},
doi = {{10.1164/rccm.202101-0055OC}},
volume = {{204}},
year = {{2021}},
}