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dc.contributor.authorBarbé Illa, Ferran
dc.contributor.authorDurán-Cantolla, Joaquín
dc.contributor.authorSánchez de la Torre, Manuel
dc.contributor.authorMartínez Alonso, Montserrat
dc.contributor.authorCarmona, Carmen
dc.contributor.authorBarceló Bennasar, Antònia
dc.contributor.authorChiner, Eusebi
dc.contributor.authorMasa, Juan F.
dc.contributor.authorGonzález, Mónica
dc.contributor.authorMarín, J. M.
dc.contributor.authorGarcía Río, Francisco
dc.contributor.authorDíaz de Atauri, María Josefa
dc.contributor.authorTerán, Joaquin
dc.contributor.authorMayós Pérez, Mercè
dc.contributor.authorPeña, Mónica de la
dc.contributor.authorMonasterio, Carmen
dc.contributor.authorCampo, Félix del
dc.contributor.authorMontserrat i Capdevila, Josep
dc.date.accessioned2016-03-08T09:28:23Z
dc.date.available2016-03-08T09:28:23Z
dc.date.issued2013
dc.identifier.issn0098-7484
dc.identifier.urihttp://hdl.handle.net/10459.1/56684
dc.description.abstractContext Continuous positive airway pressure (CPAP) is the first-line treatment for patients with symptomatic obstructive sleep apnea (OSA). However, its indication for all patients with sleep-disordered breathing, regardless of daytime symptoms, is unclear. Objective To evaluate the effect of CPAP treatment on the incidence of hypertension or cardiovascular events in a cohort of nonsleepy patients with OSA. Design, Setting, and Patients Multicenter, parallel-group, randomized controlled trial in 14 teaching hospitals in Spain. Between May 2004 and May 2006, 725 consecutive patients were enrolled who had an apnea-hypopnea index of 20 h−1 or greater and an Epworth Sleepiness Scale score of 10 or less (scores range from 0-24, with values 10 suggesting no daytime sleepiness). Exclusion criteria were previous cardiovascular event, physical or psychological incapacity, chronic disease, or drug or alcohol addiction. Follow-up ended in May 2009. Intervention Patients were allocated to receive CPAP treatment or no active intervention. All participants received dietary counseling and sleep hygiene advice. Main Outcome Measures Incidence of either systemic hypertension (taking antihypertensive medication or blood pressure greater than 140/90 mm Hg) or cardiovascular event (nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for unstable angina or arrhythmia, heart failure, or cardiovascular death). Results Seven hundred twenty-three patients underwent follow-up for a median of 4 (interquartile range, 2.7-4.4) years (1 patient from each group did not receive allocated treatment); 357 in the CPAP group and 366 in the control group were included in the analysis. In the CPAP group there were 68 patients with new hypertension and 28 cardiovascular events (17 unstable angina or arrhythmia, 3 nonfatal stroke, 3 heart failure, 2 nonfatal myocardial infarction, 2 transient ischemic attack, 1 cardiovascular death). In the control group there were 79 patients with new hypertension and 31 cardiovascular events (11 unstable angina or arrhythmia, 8 nonfatal myocardial infarction, 5 transient ischemic attack, 5 heart failure, 2 nonfatal stroke). The hypertension or cardiovascular event incidence density rate was 9.20 per 100 person-years (95% CI, 7.36-11.04) in the CPAP group and 11.02 per 100 person-years (95% CI, 8.96-13.08) in the control group. The incidence density ratio was 0.83 (95% CI, 0.63-1.1; P=.20). Conclusions In patients with OSA without daytime sleepiness, the prescription of CPAP compared with usual care did not result in a statistically significant reduction in the incidence of hypertension or cardiovascular events. However, the study may have had limited power to detect a significant difference.ca_ES
dc.description.sponsorshipThis study was funded by the Instituto de Salud Carlos III (PI 04/0165) (Fondo de Investigaciones Sanitarios, Ministerio de Sanidad y Consumo, Spain), Spanish Respiratory Society (SEPAR) (Barcelona), Resmed (Bella Vista, Australia), Air Products–Carburos Metalicos (Barcelona), Respironics (Murrysville, Pennsylvania), and Breas Medical (Madrid, Spain).
dc.language.isoengca_ES
dc.publisherAmerican Medical Associationca_ES
dc.relation.isformatofReproducció del document publicat a https://doi.org/10.1001/jama.2012.4366ca_ES
dc.relation.ispartofJAMA, 2013, vol. 307, núm. 20, p.2161-2168ca_ES
dc.rights(c) American Medical Association, 2013ca_ES
dc.titleEffect of Continuous Positive Airway Pressure on the Incidence of Hypertension and Cardiovascular Eventsin Nonsleepy Patients With Obstructive Sleep Apneaca_ES
dc.typearticleca_ES
dc.identifier.idgrec019356
dc.type.versionpublishedVersionca_ES
dc.rights.accessRightsinfo:eu-repo/semantics/openAccessca_ES
dc.identifier.doihttps://doi.org/10.1001/jama.2012.4366


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