机构：[1]the Adelaide Institute for Sleep Health[2]the School of Medicine, Faculty of Medicine, Nursing, and Health Sciences , Flinders University,[3]Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network[4]Adelaide, SA, George Institute for Global Health[5]Sydney Medical School[6]Woolcock Institute of Medical Research, University of Sydney,[7]the Departments of Respiratory and Sleep Medicine,Royal Prince Alfred Hospital, Sydney Health Partners, Sydney[8]Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney,[9]the Western Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, WA[10]the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease[11]Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou,[12]the First Affiliated Hospital of Nanjing Medical University, Nanjing[13]the Second Affiliated Hospital of Soochow University, Suzhou[14]the Department of Cardiology, Fuwai Hospital[15]George Institute for Global Health China , Peking University Health Sciences Center, Beijing,[16]the Department of Neurology, Xuzhou Central Hospital, Xuzhou[17]Hejian Municipal People’s Hospital, Hejian[18]Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai[19]University Hospital of Guadalajara, Guadalajara[20]the Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida[21]Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid[22]Instituto do Coracao (Incor) and Hospital Universitario[23]the Hypertension Unit, Renal Division, University of S?o Paulo Medical School, S?o Paulo[24]the Department of Neurology, All India Institute of Medical Sciences, Delhi[25]the Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston
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. (Funded by the National Health and Medical Research Council of Australia and others; SAVE ClinicalTrials.gov number, NCT00738179; Australian New Zealand Clinical Trials Registry number, ACTRN12608000409370.)
基金：
Supported by project grants (1006501 [2011–2015] and
1060078 [2014–2016]) from the National Health and Medical
Research Council (NHMRC) of Australia and by Respironics Sleep
and Respiratory Research Foundation and Philips Respironics.
Supplementary trial funding was provided by Fisher & Paykel
Healthcare, the Australasian Sleep Trials Network (enabling grant
343020 from the NHMRC), the Spanish Respiratory Society (grant
105-2011 to Drs. Barbe and Mediano), and Fondo de Investigaciones
Sanitarias (grant 13/02053 to Drs. Barbe and Mediano).
In-kind donations were provided by Respironics for CPAP equipment
and by ResMed for sleep apnea diagnostic devices.
第一作者机构：[1]the Adelaide Institute for Sleep Health[2]the School of Medicine, Faculty of Medicine, Nursing, and Health Sciences , Flinders University,[3]Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network[*1]the Adelaide Institute for Sleep Health, Flinders University and Respiratory and Sleep Services, Southern Adelaide Local Health Network, Repatriation General Hospital, Daw Park, Adelaide SA 5041, Australia,
通讯作者：
通讯机构：[*1]the Adelaide Institute for Sleep Health, Flinders University and Respiratory and Sleep Services, Southern Adelaide Local Health Network, Repatriation General Hospital, Daw Park, Adelaide SA 5041, Australia,[*2]the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
推荐引用方式(GB/T 7714)：
R. Doug McEvoy ,Nick A. Antic ,Emma Heeley ,et al.CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea[J].NEW ENGLAND JOURNAL OF MEDICINE.2016,375(10):919-31.doi:10.1056/NEJMoa1606599.
APA：
R. Doug McEvoy,,Nick A. Antic,,Emma Heeley,,Yuanming Luo,Qiong Ou...&Craig S. Anderson,.(2016).CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.NEW ENGLAND JOURNAL OF MEDICINE,375,(10)
MLA：
R. Doug McEvoy,,et al."CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea".NEW ENGLAND JOURNAL OF MEDICINE 375..10(2016):919-31
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