Abstract 9437: Impact of Positive Airway Pressure Therapy in Elderly Patients with Cardiovascular Disease and Sleep-disordered Breathing

Abstract

Introduction: Many studies have identified an association between sleep-disordered breathing (SDB) and cardiovascular disease (CVD). Recent studies have showed that SDB is an independent predictor of poor prognosis and continuous positive airway pressure (PAP) therapy contributes to reduce the risk. However, whether SDB is a risk factor for CVD in elderly patients and whether PAP therapy improves long-term cardiovascular outcomes are unknown. Hypothesis: We assessed the hypothesis that PAP therapy improved long-term cardiovascular outcomes in elderly patients with CVD and moderate to severe SDB. Methods: We studied 1693 patients who underwent polysomnography between November 2004 and July 2011, and enrolled 131 elderly patients (age ≥65 years old) with SDB (apnea-hypopnea index ≥15 per hour), who had been admitted to hospital due to CVD before polysomnography. They were divided into two groups; a PAP-treated group (n=64; treated with continuous positive airway pressure or adaptive servo ventilation) and an untreated SDB group (n=67; untreated with PAP devices). The frequency of death and hospitalization due to cardiovascular events (acute coronary syndrome, heart failure, stroke, fatal arrhythmias, and aortic dissection) between the groups was analyzed using multivariate analysis. Results: The mean follow-up period was 31.8 ± 23.4 months and 34 patients (26.0%) died or were re-admitted to hospital due to cardiovascular events. Kaplan-Meier survival curves indicated that event-free survival was significantly higher in the PAP-treated group than in the untreated SDB group (Figure). Multivariate analysis showed that the risk for death and re-admission due to cardiovascular events was significantly higher in the untreated SDB group than in the PAP-treated group (hazard ratio, 3.21; 95% confidence interval, 1.05 to 10.9; p <0.05). Conclusions: PAP therapy improves cardiovascular outcomes in elderly patients with CVD and moderate to severe SDB.