Trial reportChest2025
Association of Hypoxic Burden With Cardiovascular Events: A Risk Stratification Analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea Cohort.
Trial report in Chest, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT00519597 (Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea - RICCADSA Trial), which is not on this map. Cited by 14 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea - RICCADSA Trial
Who cites it
14 citing papers in PubMed.
- Dissociation between nocturnal hypoxemic burden and renin suppression: evidence of sympathetic activation in primary aldosteronism.Sleep & breathing = Schlaf & Atmung · 2026Article
- Review
- Sleep Circulation Time from Pulse Oximetry and Polysomnography: Predictive Value in Patients with Heart Failure with Reduced Ejection Fraction.Sensors (Basel, Switzerland) · 2026Article
- Objective and subjective adherence to oral appliance therapy in adults with obstructive sleep apnea: pilot data from a one-year longitudinal study.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026Article
- Impact of obstructive sleep apnoea on nocturnal blood pressure: mechanisms and treatment responses - a narrative review.European respiratory review : an official journal of the European Respiratory Society · 2026Review
- Short-term intermittent hypoxia induces biphasic apoptotic responses in the murine heart.Scientific reports · 2026Article
- Comparative Diagnostic Performance of Serum α-Klotho and FGF-23 in Predicting Obstructive Sleep Apnea Severity: A Novel Biomarker Approach.Journal of clinical medicine · 2026Article
- Social Vulnerability and Subclinical Cardiovascular Risk in Obstructive Sleep Apnea.Research square · 2026Article
- Advances in the Diagnosis and Treatment of Obstructive Sleep Apnea in Women.Pulmonary therapy · 2026Review
- Association of reduced REM sleep with mortality in adults with coronary artery disease and obstructive sleep apnea in the RICCADSA cohort.Sleep & breathing = Schlaf & Atmung · 2026Article
- Sleep Apnea-Specific Hypoxic Burden and Postoperative Outcomes of Major Noncardiothoracic Surgery.JAMA network open · 2026Observational
- Association between COMISA and cardiovascular disease: Evidence from the TURKAPNE registry.PloS one · 2026Article
- Beyond the apnea-hypopnea index: a call to action for a multidimensional evaluation in obstructive sleep apnea.Frontiers in sleep · 2026Article
- Distinct Hypoxemic Profiles of Obstructive Sleep Apnea in Southern Italy: The Living with OSA and CPAP Study.Journal of clinical medicine · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
6 authors.
Funding
Abstract
backgroundThe apnea-hypopnea index (AHI), the standard measure of OSA, has limitations in reflecting disease severity. RESEARCH QUESTION: Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI of ≥ 30 events/h? STUDY DESIGN AND
methodsThis secondary analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea observational cohort included 368 adults with OSA (AHI ≥ 15 events/h) with (n = 155) and without (n = 244) excessive daytime sleepiness (EDS), defined as an Epworth Sleepiness Scale score of ≥ 10. HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time. Patients were classified as having high or low HB based on the median (60.7%min/h). The primary outcome was the incident of the first MACCE. Cox proportional hazard models assessed associations in the full cohort and by CPAP allocation and adherence (nonadherent or no positive airway pressure [PAP] group, n = 262; adherent [adjusted PAP use ≥ 4 h/night for all nights at 1-year follow-up], n = 106). In an exploratory analysis, participants were grouped into 4 categories based on median AHI and HB (low and low, low and high, high and low, and high and high, respectively).
resultsOver a median follow-up of 4.7 years, high HB was associated with MACCEs (adjusted hazard ratio, 1.87; 95% CI, 1.17-2.98; P = .009), particularly among untreated or nonadherent patients and those with baseline EDS. AHI of ≥ 30 events/h was not associated significantly with MACCEs (P = .366). When modelled continuously, HB and AHI each were associated with MACCEs; however, compared with low AHI and low HB, only high HB, regardless of AHI level, was linked to increased risk. In contrast, high AHI and low HB was not associated with MACCEs.
interpretationHigh HB, but not AHI of ≥ 30 events/h, was associated with MACCEs in adults with moderate to severe OSA. Although AHI was associated with outcomes when modelled continuously, elevated risk seemed to be driven primarily by high HB. CLINICAL
trial registrationClinicalTrials.gov; No.: NCT00519597; URL: www. CLINICALTRIALS: gov.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.