{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:15:38Z","timestamp":1788344138521,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1006501 (2011\u20132015)"],"award-info":[{"award-number":["1006501 (2011\u20132015)"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1060078 (2014\u20132016))"],"award-info":[{"award-number":["1060078 (2014\u20132016))"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022617","name":"Fisher and Paykel Healthcare","doi-asserted-by":"publisher","award":["343020"],"award-info":[{"award-number":["343020"]}],"id":[{"id":"10.13039\/501100022617","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats: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\u2013severe OSA and established CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Post hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants from 89 clinical centres in seven countries with moderate\u2010to\u2010severe 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\u2009\u2264\u20090.210), moderately frail (FI 0.211\u20130.310) and severely frail (FI\u2009\u2265\u20090.311). Cox proportional hazards models were used to assess associations of FI and both composite and individual cardiovascular outcomes over an average follow\u2010up period of 3.7\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20133.11), and separately for stroke (HR, 2.40; 95% CI, 1.54\u20133.74), hospitalisation for unstable angina (HR, 2.94; 95% CI, 1.98\u20134.35), all\u2010cause mortality (HR, 1.77; 95% CI, 1.01\u20133.11) and CVD death (HR, 2.51; 95% CI, 1.13\u20135.60), during a mean 3.7\u2009years of follow\u2010up. There was a similar level of adherence to CPAP treatment (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.488) across baseline frailty groups and no heterogeneity in the effect of CPAP treatment on composite and separate cardiovascular events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the SAVE cohort of adults with co\u2010occurring 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.<\/jats:p>\n                    <jats:p>Trial Registration: ClinicalTrials.gov identifier: NCT00738179.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70252","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T07:18:10Z","timestamp":1773904690000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Frailty and Recurrent Cardiovascular Events in Patients With Obstructive Sleep Apnoea: The SAVE Study"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6059-0853","authenticated-orcid":false,"given":"Shoujiang","family":"You","sequence":"first","affiliation":[{"name":"Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University  Suzhou 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Flinders University  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Peters","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferran","family":"Barb\u00e9","sequence":"additional","affiliation":[{"name":"Respiratory Department Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Respiratorias, Institut de Recerca Biom\u00e9dica de Lleida  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linan","family":"Chen","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Chen","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjun","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Feng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldo","family":"Lorenzi\u2010Filho","sequence":"additional","affiliation":[{"name":"Instituto do Coracao (Incor) and Hospital Universitario  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Woodward","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"},{"name":"The George Institute for Global Health, School of Public Health Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chalmers","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig\u00a0S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine University of New South Wales  Sydney Australia"},{"name":"The Institute of Science and Technology for Brain\u2010Inspired Research Fudan University  Shanghai China"},{"name":"Neurology Department Royal Prince Alfred Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the SAVE 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