{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T14:17:13Z","timestamp":1786457833532,"version":"build-2736575974"},"reference-count":38,"publisher":"European Respiratory Society (ERS)","issue":"5","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/publications.ersnet.org\/user-licence"}],"funder":[{"DOI":"10.13039\/501100007509","name":"Sociedad Espa\u00f1ola de Neumolog\u00eda y Cirug\u00eda Tor\u00e1cica","doi-asserted-by":"publisher","award":["SEPAR\/2007"],"award-info":[{"award-number":["SEPAR\/2007"]}],"id":[{"id":"10.13039\/501100007509","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FISS PI04\/1684"],"award-info":[{"award-number":["FISS PI04\/1684"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FISS PS09\/02449"],"award-info":[{"award-number":["FISS PS09\/02449"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2025,8,8]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence regarding the efficacy of positive airway pressure (PAP) therapy in reducing the risk of non-fatal major cardiovascular events (NF-MACE) and mortality in patients with obstructive sleep apnoea (OSA) remains controversial. This study aims to quantify the impact of PAP therapy on these risks and develop a predictive risk estimator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicentre, observational, prospective study involving 5358 individuals diagnosed with OSA, with a median (interquartile range (IQR)) follow-up of 14 (10\u201315)\u2005years. We derived and validated a risk estimator of NF-MACE (including myocardial infarction, stroke, revascularisation procedures and congestive heart failure) and all-cause mortality, incorporating PAP adherence alongside clinical and sleep-related data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort had mean\u00b1\n                      <jats:sc>sd<\/jats:sc>\n                      age 55\u00b111\u2005years, body mass index 32.0\u00b15.4\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      and apnoea\u2013hypopnoea index (AHI) 35\u00b122\u2005events\u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      ; 26% were females and 1467 (37%) were PAP adherent. Over the follow-up period, 754 participants experienced NF-MACE, while 858 deaths were recorded. Significant predictors included prior cardiovascular events, non-high-density lipoprotein cholesterol \u2265200\u2005mg\u00b7dL\n                      <jats:sup>\u22121<\/jats:sup>\n                      , COPD diagnosis, AHI &gt;30\u2005events\u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      and age &gt;60\u2005years. PAP adherence was protective (OR 0.46, 95% CI 0.38\u20130.56) and the absolute risk reduction varied depending on the baseline risk (median (IQR) 16% (12\u201318%)). The risk estimator yielded an area under the receiver operating characteristic curve of 0.75 and a Brier score of 0.17, with 64% sensitivity and 75% specificity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PAP therapy is associated with long-term risk reduction of NF-MACE and mortality in OSA patients, while the developed risk estimator enhances clinical decision making regarding therapy initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.00519-2025","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T14:45:24Z","timestamp":1755787524000},"page":"2500519","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Major cardiovascular event or death risk in obstructive sleep apnoea and the effect of positive airway pressure"],"prefix":"10.1183","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0770-7653","authenticated-orcid":false,"given":"Miguel J.","family":"Divo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-1891","authenticated-orcid":false,"given":"Miguel A.","family":"Martinez-Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Campos-Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Lloberes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Marin-Oto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Forner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sanz-Rubio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Nieto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7266-8371","authenticated-orcid":false,"given":"Bartolome R.","family":"Celli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9096-2294","authenticated-orcid":false,"given":"Jose M.","family":"Marin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"2025121603401938000_66.5.2500519.1","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir Med"},{"key":"2025121603401938000_66.5.2500519.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.901801"},{"key":"2025121603401938000_66.5.2500519.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0229"},{"key":"2025121603401938000_66.5.2500519.4","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200911-1746OC"},{"key":"2025121603401938000_66.5.2500519.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1513\/AnnalsATS.202409-981ST","article-title":"The great controversy of obstructive sleep apnea treatment for cardiovascular risk benefit: advancing the science through expert consensus. 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