Shoujiang You, Danni Zheng, Katie Harris, Kelly A. Loffler, R. Doug McEvoy, Ruth Peters, Qiang Li, Ferran Barbé, Linan Chen, Xiaoying Chen, Yongjun Cao, Chun-Feng Liu, Geraldo Lorenzi-Filho, Mark Woodward, John Chalmers, Craig S. Anderson, the SAVE Investigators
{"title":"阻塞性睡眠呼吸暂停患者的虚弱和复发性心血管事件：SAVE研究","authors":"Shoujiang You, Danni Zheng, Katie Harris, Kelly A. Loffler, R. Doug McEvoy, Ruth Peters, Qiang Li, Ferran Barbé, Linan Chen, Xiaoying Chen, Yongjun Cao, Chun-Feng Liu, Geraldo Lorenzi-Filho, Mark Woodward, John Chalmers, Craig S. Anderson, the SAVE Investigators","doi":"10.1002/jcsm.70252","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Frailty is a common syndrome in patients with cardiovascular disease (CVD). Whether frailty modifies the risk of recurrent cardiovascular events in patients with established CVD and obstructive sleep apnoea (OSA) is uncertain. We aimed to determine associations of frailty and the risk of recurrent cardiovascular events in adults with moderate–severe OSA and established CVD.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Post hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants from 89 clinical centres in seven countries with moderate-to-severe OSA and established CVD were randomised to usual care plus continuous positive airway pressure (CPAP) treatment or usual care alone. Participants were categorised using the Rockwood frailty index (FI) into three groups: nonfrail (FI ≤ 0.210), moderately frail (FI 0.211–0.310) and severely frail (FI ≥ 0.311). Cox proportional hazards models were used to assess associations of FI and both composite and individual cardiovascular outcomes over an average follow-up period of 3.7 years.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>There were 2653 OSA participants (mean age 61.3 [SD 7.8] years, and 507 [19.1%] were female) with established CVD included with a mean FI of 0.290 (SD 0.125). There were 783 (29.5%) and 1006 (37.9%) classified as moderately and severely frail, respectively. Compared to those without frailty, those with severe frailty had increased risks of the composite cardiovascular endpoint (hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.88–3.11), and separately for stroke (HR, 2.40; 95% CI, 1.54–3.74), hospitalisation for unstable angina (HR, 2.94; 95% CI, 1.98–4.35), all-cause mortality (HR, 1.77; 95% CI, 1.01–3.11) and CVD death (HR, 2.51; 95% CI, 1.13–5.60), during a mean 3.7 years of follow-up. There was a similar level of adherence to CPAP treatment (<i>p</i> = 0.488) across baseline frailty groups and no heterogeneity in the effect of CPAP treatment on composite and separate cardiovascular events.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>In the SAVE cohort of adults with co-occurring OSA and CVD, a higher FI was associated with significantly higher risk of recurrent cardiovascular events. Frailty did not modify CPAP treatment adherence or the effect of CPAP on recurrent cardiovascular events.</p>\n \n <p>Trial Registration: ClinicalTrials.gov identifier: NCT00738179.</p>\n </section>\n </div>","PeriodicalId":48911,"journal":{"name":"Journal of Cachexia Sarcopenia and Muscle","volume":"17 2","pages":""},"PeriodicalIF":9.1000,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcsm.70252","citationCount":"0","resultStr":"{\"title\":\"Frailty and Recurrent Cardiovascular Events in Patients With Obstructive Sleep Apnoea: The SAVE Study\",\"authors\":\"Shoujiang You, Danni Zheng, Katie Harris, Kelly A. Loffler, R. Doug McEvoy, Ruth Peters, Qiang Li, Ferran Barbé, Linan Chen, Xiaoying Chen, Yongjun Cao, Chun-Feng Liu, Geraldo Lorenzi-Filho, Mark Woodward, John Chalmers, Craig S. Anderson, the SAVE Investigators\",\"doi\":\"10.1002/jcsm.70252\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Frailty is a common syndrome in patients with cardiovascular disease (CVD). Whether frailty modifies the risk of recurrent cardiovascular events in patients with established CVD and obstructive sleep apnoea (OSA) is uncertain. We aimed to determine associations of frailty and the risk of recurrent cardiovascular events in adults with moderate–severe OSA and established CVD.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Post hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants from 89 clinical centres in seven countries with moderate-to-severe OSA and established CVD were randomised to usual care plus continuous positive airway pressure (CPAP) treatment or usual care alone. Participants were categorised using the Rockwood frailty index (FI) into three groups: nonfrail (FI ≤ 0.210), moderately frail (FI 0.211–0.310) and severely frail (FI ≥ 0.311). Cox proportional hazards models were used to assess associations of FI and both composite and individual cardiovascular outcomes over an average follow-up period of 3.7 years.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>There were 2653 OSA participants (mean age 61.3 [SD 7.8] years, and 507 [19.1%] were female) with established CVD included with a mean FI of 0.290 (SD 0.125). There were 783 (29.5%) and 1006 (37.9%) classified as moderately and severely frail, respectively. Compared to those without frailty, those with severe frailty had increased risks of the composite cardiovascular endpoint (hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.88–3.11), and separately for stroke (HR, 2.40; 95% CI, 1.54–3.74), hospitalisation for unstable angina (HR, 2.94; 95% CI, 1.98–4.35), all-cause mortality (HR, 1.77; 95% CI, 1.01–3.11) and CVD death (HR, 2.51; 95% CI, 1.13–5.60), during a mean 3.7 years of follow-up. There was a similar level of adherence to CPAP treatment (<i>p</i> = 0.488) across baseline frailty groups and no heterogeneity in the effect of CPAP treatment on composite and separate cardiovascular events.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>In the SAVE cohort of adults with co-occurring OSA and CVD, a higher FI was associated with significantly higher risk of recurrent cardiovascular events. 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Frailty and Recurrent Cardiovascular Events in Patients With Obstructive Sleep Apnoea: The SAVE Study
Background
Frailty is a common syndrome in patients with cardiovascular disease (CVD). Whether frailty modifies the risk of recurrent cardiovascular events in patients with established CVD and obstructive sleep apnoea (OSA) is uncertain. We aimed to determine associations of frailty and the risk of recurrent cardiovascular events in adults with moderate–severe OSA and established CVD.
Methods
Post hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants from 89 clinical centres in seven countries with moderate-to-severe OSA and established CVD were randomised to usual care plus continuous positive airway pressure (CPAP) treatment or usual care alone. Participants were categorised using the Rockwood frailty index (FI) into three groups: nonfrail (FI ≤ 0.210), moderately frail (FI 0.211–0.310) and severely frail (FI ≥ 0.311). Cox proportional hazards models were used to assess associations of FI and both composite and individual cardiovascular outcomes over an average follow-up period of 3.7 years.
Results
There were 2653 OSA participants (mean age 61.3 [SD 7.8] years, and 507 [19.1%] were female) with established CVD included with a mean FI of 0.290 (SD 0.125). There were 783 (29.5%) and 1006 (37.9%) classified as moderately and severely frail, respectively. Compared to those without frailty, those with severe frailty had increased risks of the composite cardiovascular endpoint (hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.88–3.11), and separately for stroke (HR, 2.40; 95% CI, 1.54–3.74), hospitalisation for unstable angina (HR, 2.94; 95% CI, 1.98–4.35), all-cause mortality (HR, 1.77; 95% CI, 1.01–3.11) and CVD death (HR, 2.51; 95% CI, 1.13–5.60), during a mean 3.7 years of follow-up. There was a similar level of adherence to CPAP treatment (p = 0.488) across baseline frailty groups and no heterogeneity in the effect of CPAP treatment on composite and separate cardiovascular events.
Conclusions
In the SAVE cohort of adults with co-occurring OSA and CVD, a higher FI was associated with significantly higher risk of recurrent cardiovascular events. Frailty did not modify CPAP treatment adherence or the effect of CPAP on recurrent cardiovascular events.
期刊介绍：
The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.
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