European Respiratory Journal最新文献

{"title":"Pirfenidone in idiopathic pulmonary fibrosis: hitting two birds with one stone?","authors":"Sydney B Montesi, Yet H Khor","doi":"10.1183/13993003.02224-2024","DOIUrl":"https://doi.org/10.1183/13993003.02224-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":"65 2","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pirfenidone and risk of lung cancer development in idiopathic pulmonary fibrosis: a nationwide population-based study.","authors":"Hee-Young Yoon, Hoseob Kim, Yoonjong Bae, Jin Woo Song","doi":"10.1183/13993003.01484-2024","DOIUrl":"10.1183/13993003.01484-2024","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) carries a high risk of lung cancer, but the effect of pirfenidone on lung cancer development remains uncertain. We investigated the association between pirfenidone use and lung cancer development in patients with IPF.</p><p><strong>Methods: </strong>We included 9938 patients with IPF from the Korean national claims database. Propensity score analysis with inverse probability of treatment weighting (IPTW) and landmark analyses were employed to evaluate lung cancer occurrence according to pirfenidone use. The association was evaluated using Cox regression models adjusted for clinical and socioeconomic variables. A single-centre IPF clinical cohort (n=941) was used for validating the findings.</p><p><strong>Results: </strong>The mean patient age was 69.4 years, 73.7% were men and 32.1% received pirfenidone. Lung cancer developed in 766 patients with IPF (7.7%; 21.9 cases per 1000 person-years) during a median follow-up of 3.0 years. After IPTW, the pirfenidone group showed lower incidence (10.4 <i>versus</i> 27.9 cases per 1000 person-years) than the no pirfenidone group. Landmark analysis at 6 months after IPF diagnosis also showed lower incidence of lung cancer in the pirfenidone group than in the no pirfenidone group. Pirfenidone use was independently associated with a reduced lung cancer risk (weighted adjusted hazard ratio (HR) 0.347, 95% CI 0.258-0.466). A clinical cohort showed similar association (weighted adjusted HR 0.716, 95% CI 0.517-0.991). The association persisted across subgroups defined by age or sex.</p><p><strong>Conclusion: </strong>Pirfenidone use may be associated with a reduced lung cancer risk in patients with IPF.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The volume-outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension.","authors":"Samuel Heuts, Michal J Kawczynski, Arthur Leus, Laurent Godinas, Catharina Belge, Vanessa van Empel, Bart Meyns, Jos G Maessen, Marion Delcroix, Tom Verbelen","doi":"10.1183/13993003.01865-2024","DOIUrl":"10.1183/13993003.01865-2024","url":null,"abstract":"<p><strong>Background: </strong>We conducted a volume-outcome meta-analysis of pulmonary endarterectomy procedures for chronic thromboembolic pulmonary hypertension to objectively determine the minimum required annual case load that can define a high-volume centre.</p><p><strong>Methods: </strong>Three electronic databases were systematically queried up to 1 May 2024. Centres were divided in volume tertiles. The primary outcomes were early mortality and long-term survival. Restricted cubic splines were used to demonstrate the volume-outcome relationship and the elbow-method was applied to define high-volume centres. Long-term survival was assessed using Cox frailty models.</p><p><strong>Results: </strong>We included 51 centres (52 consecutive cohorts) and divided them into tertiles (T1: <6 cases per year; T2: 6-15 cases per year, T3: >15 cases per year), comprising a total 11 345 patients (mean age 52.3 years). Overall early mortality was 6.0% (T1: 11.6%; T2: 7.2%; T3: 5.2%; p<0.001), for which a significant nonlinear volume-outcome relationship was observed (p=0.0437) with a statistically determined minimal required volume of 33 cases per year (95% CI 29-35 cases), and a modelled volume of 40 cases per year corresponding to a 5.0% mortality rate. Nevertheless, early mortality still progressively declined in higher volume centres (from 6.7% to 5.4% to 2.9% in centres performing 16-50, 51-100 and >100 procedures annually). In addition, a significant volume effect was observed for long-term survival (adjusted hazard ratio per tertile 0.75, 95% CI 0.63-0.89; p=0.001).</p><p><strong>Conclusion: </strong>There is a significant association between procedural volume and early mortality in pulmonary endarterectomy. An annual procedural volume of >33-40 cases per year may be used to define a high‑volume centre, although higher volumes still lead to progressively lower mortality rates.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of continuous positive airway pressure on blood pressure in normotensive individuals with obstructive sleep apnoea: a randomised trial.","authors":"Adriano D S Targa, Gerard Torres, Iván D Benítez, Mario Henríquez-Beltrán, Rafaela Vaca, Lidia Pascual Arnó, Olga Minguez, Maria Aguilà, Dolores Martínez, Lucía Pinilla, Anna Galan Gonzalez, Sergi Balsells Garriga, Manuel Sánchez-de-la-Torre, Ferran Barbé","doi":"10.1183/13993003.01954-2024","DOIUrl":"https://doi.org/10.1183/13993003.01954-2024","url":null,"abstract":"<p><p>The use of continuous positive airway pressure prevents an increase in blood pressure in normotensive subjects with a dipping blood pressure pattern and severe obstructive sleep apnoea.</p><p><strong>Background: </strong>The effects of continuous positive airway pressure (CPAP) on blood pressure (BP) in normotensive subjects, particularly among those with a dipping BP pattern, remain uncertain, raising questions about its indication for this group of patients. We assessed the impact of CPAP on BP in normotensive subjects with a dipping BP pattern and severe obstructive sleep apnoea (OSA).</p><p><strong>Methods: </strong>Randomised, parallel, prospective, controlled trial. Inclusion criteria were an apnoea-hypopnea index ≥30 events/hour, mean 24-hour BP <130/80 mmHg, and daytime-to-nighttime BP reduction ≥10%. Patients were randomly assigned to receive either CPAP treatment or usual care for 12 weeks. The primary outcome was the change in ambulatory BP monitoring (ABPM) parameters from baseline to the three-month follow-up.</p><p><strong>Results: </strong>The 60 patients who completed the follow-up had a mean age of 52.2 years (sd 10.8), and 40 of them (66.7%) were male. The intention-to-treat analysis showed no significant changes with CPAP, whereas the usual care group experienced increases in ABPM parameters. This resulted in a mean difference of -3.4 mmHg (95% CI: -6.124 to -0.676; p=0.015) in nighttime diastolic BP between the groups. The per-protocol analysis indicated significant differences between the CPAP and usual care groups for all primary endpoints, except for daytime systolic BP. For nighttime systolic BP, the difference was -6.052 mmHg (95% CI: -10.895 to -1.208; p=0.016).</p><p><strong>Conclusion: </strong>These findings suggest a protective effect of CPAP, highlighting the importance of CPAP prescription for this population to control potential increases in blood pressure and possibly prevent the onset of hypertension.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xenon-129 magnetic resonance imaging and spectroscopy detects response to therapy in pulmonary hypertension.","authors":"Fawaz Alenezi, Anna Costelle, Prerna Sharma, Megan Barrett, Elianna A Bier, Bastiaan Driehuys, Sudarshan Rajagopal","doi":"10.1183/13993003.01651-2024","DOIUrl":"10.1183/13993003.01651-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mannose-6-phosphate attenuates acute lung injury by competitive release of acid sphingomyelinase from the mannose-6-phosphate receptor in endothelial caveolae.","authors":"Tian Jiang, Rudi Samapati, Sergej Klassen, Supandi Winoto-Morbach, Zain H Mohamed, Rolf Göggel, Jun Yin, Lijie Tan, Christoph Arenz, Sabrina Schulz, Lasti Erfinanda, Robert Preissner, Szandor Simmons, Stefan Schütze, Stefan Uhlig, Wolfgang M Kuebler","doi":"10.1183/13993003.00003-2024","DOIUrl":"https://doi.org/10.1183/13993003.00003-2024","url":null,"abstract":"<p><strong>Background: </strong>Platelet-activating factor (PAF)-induced pulmonary endothelial barrier failure is mediated by acid sphingomyelinase (ASM) translocation to caveolae. ASM, however, lacks a transmembrane domain for anchoring inside caveolae. We hypothesized that ASM may anchor to cation-independent mannose-6-phosphate receptor (CI-M6PR) in caveolae from where it can be competitively released by M6P.</p><p><strong>Methods: </strong>We probed for ASM-CI-M6PR interaction by co-immunoprecipitation (Co-IP) and proximity ligation assay (PLA) in isolated lungs and human pulmonary microvascular endothelial cells (hPMVECs). ASM release by M6P was determined in hPMVECs, isolated lungs and <i>in vivo</i>. Effects of M6P i) on PAF-induced lung edema formation and endothelial Ca²⁺ concentration ([Ca²⁺]_i), and ii) lung injury in acid instilled, overventilated mouse lungs were tested. ASM levels were measured in serum and bronchoalveolar lavage fluid (BALF) of ARDS patients. The TriNetX database was probed for the association of ASM-inhibiting tricyclic antidepressants (TCA) with outcome.</p><p><strong>Results: </strong>Co-IP and PLA revealed ASM interaction with CI-M6PR in endothelial caveolae, which was further increased by PAF. M6P, but not glucose-6-phosphate (Glu6P) caused ASM release, thereby decreasing ASM content and activity in caveolae <i>in vitro</i>, <i>in situ</i> and <i>in vivo</i>. Analogously, M6P, yet not Glu6P attenuated PAF-induced endothelial [Ca²⁺]_i signaling and lung edema <i>in situ</i>, and acute lung injury <i>in vivo</i>. ASM levels were increased in serum, yet not BALF in ARDS patients. Use of TCA was associated with better outcome in patients with severe respiratory infections.</p><p><strong>Conclusions: </strong>CI-M6PR anchors ASM in caveolae. M6P may hence present a promising strategy against ASM-related lung injury and edema.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomic profiling of the airway epithelium in COPD links airway eosinophilia to type 2 inflammation and corticosteroid response.","authors":"Clarus Leung, Hye Yun Park, Xuan Li, Graeme J Koelwyn, Josie Tuong, Seyed Milad Vahedi, Fernando Sergio Leitao Filho, Julia S Yang, Rachel L Eddy, Stephen Milne, Min Hyung Ryu, Hiroto Takiguchi, Kentaro Akata, Seung Won Ra, Ji-Yong Moon, Hyun Kuk Kim, Yuji Cho, Kei Yamasaki, Stephan F van Eeden, Tawimas Shaipanich, Stephen Lam, Janice M Leung, Don D Sin","doi":"10.1183/13993003.01875-2024","DOIUrl":"https://doi.org/10.1183/13993003.01875-2024","url":null,"abstract":"<p><strong>Background: </strong>A subset of COPD patients have high levels of eosinophils in the distal airways (\"airway eosinophilia\").</p><p><strong>Objectives: </strong>To compare the gene expression of type 2 inflammation in airway epithelial brushings of COPD patients with and without airway eosinophilia and to investigate the changes after inhaled corticosteroids (ICS).</p><p><strong>Methods: </strong>Post-hoc analyses of the DISARM randomised controlled trial investigated the expression of airway inflammation (type 1, 2, and 17), IL-13, and mast cell gene signatures at baseline and after 12-week ICS treatment. Gene signatures were generated from RNA sequencing of airway epithelial brushings. Airway eosinophilia was defined as eosinophils>1% of the total leukocyte count in bronchoalveolar lavage. Gene set enrichment analyses identified upregulated canonical pathways in airway eosinophilia.</p><p><strong>Results: </strong>Among 58 COPD patients, 38% had airway eosinophilia at baseline. Patients with airway eosinophilia had more severe airflow obstruction and more radiographic emphysema than the non-eosinophilia group. Patients with airway eosinophilia showed a higher epithelial expression of type 2 airway inflammation and IL-13 and mast cell activation at baseline, but the expression of type 1 and type 17 airway inflammation was similar to patients without airway eosinophilia. The airway eosinophilia group showed an upregulation of canonical pathways related to type 2 immune response and asthma. Treatment with ICS for 12 weeks reduced the epithelial expression of type 2 inflammation and mast cell gene signatures in patients with airway eosinophilia, while this change was not significant in patients without airway eosinophilia.</p><p><strong>Conclusions: </strong>Airway eosinophilia marks a subset of COPD patients with increased airway epithelial expression of type 2 inflammation and a response to ICS treatment.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct mural cells and fibroblasts promote pathogenic plasma cell accumulation in idiopathic pulmonary fibrosis.","authors":"Zhi Yang, Gaoyuan Cao, Xiaosheng Tan, Sarah Orfanos, Joseph Jude, Gaetan Barbet, Steven S An, Dianhua Jiang, Reynold A Panettieri, Qi Yang","doi":"10.1183/13993003.01114-2024","DOIUrl":"https://doi.org/10.1183/13993003.01114-2024","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) is characterized by significant, but poorly understood immune and antibody responses. This study examines the spatial transcriptomes and microenvironmental niches of antibody-producing plasma cells and tertiary lymphoid structures (TLS) in IPF lungs, and the molecular pathways influencing antibody accumulation and pulmonary fibrosis.</p><p><strong>Methods: </strong>Explant lung tissues from IPF patients and control normal lungs were used for spatial transcriptome assays and validating RNA-scope and immunofluorescence assays. Fibroblasts derived from IPF and control lungs were examined for their capability to attract plasma cells. Neutralizing antibodies were administered to investigate molecules affecting pulmonary plasma cell accumulation and fibrosis in bleomycin-treated mice.</p><p><strong>Results: </strong>Human IPF lungs exhibited a remarkably widespread distribution of plasma cells and local antibodies in the fibrotic regions, disseminating from plasma cell-generating TLS. Novel mural cells wrapped the vessels in TLS regions, expressing CCR7 ligands that attracted T cells into TLS to promote plasma cell generation. Distinct IPF-associated fibroblasts further secreted CXCL12, providing an extramedullary niche to foster the dissemination and accumulation of plasma cells in the fibrotic regions. Neutralization of CCR7 ligands or CXCL12 reduced plasma cell and local antibody accumulation in the lungs of bleomycin-treated mice, leading to reduced TGFβ concentrations and alleviated pulmonary fibrosis.</p><p><strong>Conclusions: </strong>Plasma cells and local antibodies are widely distributed in the fibrotic regions of IPF lungs. Distinct subsets of IPF-associated mural cells and fibroblasts promote pathological plasma cell and antibody accumulation. These findings have potential implications for strategies aimed at targeting immune and antibody responses to combat IPF.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incident tuberculosis in people with HIV across Europe from 2012-2022: incidence rates, risk factors, and regional differences in a multicentre cohort study.","authors":"Christian Kraef, Ashley Roen, Daria Podlekareva, Elzbieta Bakowska, Johannes Nemeth, Michael Knappik, Marie-Christine Payen, Ferdinand Wit, Christina Mussini, Antonella d'Arminio Monforte, Antonella Castagna, Nikoloz Chkhartishvili, Bastian Neesgaard, Nadine Jaschinski, Alain Volny Anne, Elena Borodulina, Marie Ballief, Elmar Wallner, Dennis Israelski, Harmony Garges, Amanda Mocroft, Ole Kirk","doi":"10.1183/13993003.01904-2024","DOIUrl":"https://doi.org/10.1183/13993003.01904-2024","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis remains the leading cause of death among people with HIV. The aim of this study was to describe the incidence of tuberculosis (TB), explore risk factors and to calculate their population attributable fractions (PAF) in people with HIV across Europe, stratified by region.</p><p><strong>Method: </strong>Longitudinal study of people with HIV aged>18 years with follow-up from either 1/1/2012, or cohort enrolment, until date of TB diagnosis, last visit, death, or 31/12/2022. Factors associated with TB, in particular antiretroviral therapy status and smoking, were analysed using multivariable Poisson regression.</p><p><strong>Results: </strong>A total of 38 837 participants with HIV with a median follow-up of 7.7 (4.3-10.4) years. Overall, 306 TB cases were diagnosed during 275 811 person-years of follow-up (PYFU; incidence rate (IR) 1.03/1000 PYFU, 95% CI 0.91-1.11). 3.3% (<i>n</i>=81/2428) participants had incident TB in Eastern Europe (IR 6.13, 4.93-7.62). Overall, the IR decreased from 2.03 (1.53-2.68) in 2012 to 0.44 (0.20-0.97) in 2022. Modifiable risk factors were smoking (adjusted incidence rate ratio 2.94; 95%CI1.62-5.34) and not receiving antiretroviral therapy (<i>versus</i> on; 3.29; 2.36-4.58). A history of TB pre-baseline increased the risk of recurrence (aIRR 7.77; 95%CI 4.09-14.74). The PAF for not receiving antiretroviral therapy was 34.6% in Non-Eastern Europe and 31.2% in Eastern Europe.</p><p><strong>Conclusions: </strong>TB incidence has been decreasing among people with HIV, but remains more frequent in Eastern Europe. Improvement of antiretroviral therapy-coverage and adherence and a focus on non-communicable disease risk factors such as smoking could reduce the incidence of TB.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Rate response and cardiovascular risk during OSA: an easy biomarker derived from pulse oximetry.","authors":"Margaux Blanchard, Théo Imler, Wen-Hsin Hu, Adrien Waeber, Geoffroy Solelhac, José Haba-Rubio, Sandrine Kerbrat, Abdelkebir Sabil, Wojciech Trzepizur, François Goupil, Audrey Thomas, Sébastien Bailly, Ali Azarbarzin, Peter Vollenweider, Pedro Marques-Vidal, Julien Vaucher, Raphael Heinzer, Frédéric Gagnadoux","doi":"10.1183/13993003.01883-2024","DOIUrl":"https://doi.org/10.1183/13993003.01883-2024","url":null,"abstract":"<p><strong>Background: </strong>Sleep apnoea specific heart rate response (ΔHR) has been identified as a promising biomarker for stratifying cardiovascular (CV) risk, and predicting positive airway pressure (PAP) benefit in obstructive sleep apnoea (OSA). However, the need for prior manual scoring of respiratory events potentially limits the accessibility and reproducibility of ΔHR. We aimed to evaluate the association of pulse rate response to oxygen desaturations automatically derived from pulse oximetry (ΔHR_oxi) with CV risk in OSA.</p><p><strong>Methods: </strong>ΔHR_oxi and ΔHR were measured in OSA patients from the <i>IRSR Pays de la Loire Sleep Cohort</i> (<i>PLSC;</i> n=5,002) and the <i>HypnoLaus</i> cohort (n=1,307). The primary outcome was major adverse CV events (MACEs), a composite of mortality, stroke, and cardiac diseases. Cox regressions analyses were conducted to evaluate the association of ΔHR_oxi and ΔHR categorized into low, midrange and high categories, with MACEs.</p><p><strong>Results: </strong>MACEs occured in 768 patients from <i>PLSC</i> and 87 patients from <i>HypnoLaus</i> (median follow-up: 8.0 and 7.5 years respectively). Multivariable Cox models showed that subjects with high ΔHR_oxi (vs midrange) had higher risk of MACEs in <i>PLSC</i> (hazard ratio, HR: 1.42 [95% CI:1.18-1.71]) and <i>HypnoLaus</i> (HR: 1.72 [1.03-2.87]). Similar findings were observed for high ΔHR. Among 2,718 patients from <i>PLSC</i> treated with PAP, the association of PAP adherence (PAP use ≥4 h/night, vs non adherence) with MACEs was modified by baseline ΔHR and ΔHR_oxi (p for interaction<0.05).</p><p><strong>Conclusions: </strong>ΔHR_oxi could constitute a reliable and easy to measure biomarker for stratifying CV risk and predicting CV benefit of PAP in OSA.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}