{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:38:18Z","timestamp":1793932698107,"version":"4.8.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,10,3]]},"abstract":"\n Importance<\/jats:title>\n The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of adverse cardiovascular events in randomized clinical trials.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n PubMed (MEDLINE), EMBASE, Current Controlled Trials: metaRegister of Controlled Trials, ISRCTN Registry, European Union clinical trials database, CENTRAL (Cochrane Central Register of Controlled Trials), and ClinicalTrials.gov databases were systematically searched through June 22, 2023.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n For qualitative and individual participant data (IPD) meta-analysis, randomized clinical trials addressing the therapeutic effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA were included.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n \n Two reviewers independently screened records, evaluated potentially eligible primary studies in full text, extracted data, and cross-checked errors. IPD were requested from authors of the selected studies (SAVE [\n NCT00738179<\/jats:ext-link>\n ], ISAACC [\n NCT01335087<\/jats:ext-link>\n ], and RICCADSA [\n NCT00519597<\/jats:ext-link>\n ]).\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n One-stage and 2-stage IPD meta-analyses were completed to estimate the effect of CPAP treatment on risk of recurrent major adverse cardiac and cerebrovascular events (MACCEs) using mixed-effect Cox regression models. Additionally, an on-treatment analysis with marginal structural Cox models using inverse probability of treatment weighting was fitted to assess the effect of good adherence to CPAP (\u22654 hours per day).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 4186 individual participants were evaluated (82.1% men; mean [SD] body mass index, 28.9 [4.5]; mean [SD] age, 61.2 [8.7] years; mean [SD] apnea-hypopnea index, 31.2 [17] events per hour; 71% with hypertension; 50.1% receiving CPAP [mean {SD} adherence, 3.1 {2.4} hours per day]; 49.9% not receiving CPAP [usual care], mean [SD] follow-up, 3.25 [1.8] years). The main outcome was defined as the first MACCE, which was similar for the CPAP and no CPAP groups (hazard ratio, 1.01 [95% CI, 0.87-1.17]). However, an on-treatment analysis by marginal structural model revealed a reduced risk of MACCEs associated with good adherence to CPAP (hazard ratio, 0.69 [95% CI, 0.52-0.92]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.17465","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T11:02:49Z","timestamp":1696330969000},"page":"1255","source":"Crossref","is-referenced-by-count":235,"title":["Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events"],"prefix":"10.1001","volume":"330","author":[{"given":"Manuel","family":"S\u00e1nchez-de-la-Torre","sequence":"first","affiliation":[{"name":"Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa 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