A consensus opinion amongst stakeholders as to benefits of obstructive sleep apnoea treatment for cardiovascular health.

Blood Pressure Cardiovascular Diseases / complications Consensus Continuous Positive Airway Pressure Heart Failure / complications Humans Hypertension / complications Severity of Illness Index Sleep Apnea, Obstructive / complications Ventricular Function, Left
blood pressure cardiovascular diseases sleep apnoea treatment

Journal

Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368

Informations de publication

Date de publication:
04 2019
Historique:
received: 15 05 2018
revised: 23 07 2018
accepted: 05 09 2018
pubmed: 5 10 2018
medline: 30 4 2020
entrez: 5 10 2018
Statut: ppublish

Résumé

Obstructive sleep apnoea (OSA) is a prevalent sleep disorder associated with increased cardiovascular morbidity and mortality. Whether treatment of OSA improves cardiovascular risk remains controversial. Our aim was to determine a consensus opinion of key sleep medicine stakeholder groups as to the cardiovascular benefits of treating moderate-severe OSA. A multidisciplinary panel was assembled from representatives from the Australasian Sleep Association, Sleep Health Foundation, Australasian Sleep Technologists Association, the Sleep Health Foundation Business Council and the Sleep Disorders Australia patient support group. Three statements reflecting areas of controversy related to cardiovascular benefits of OSA treatment were created. A modified RAND/UCLA appropriateness methodology was applied determining the panel's level of consensus and agreement with each statement. Voting results indicated the panel: (1) remained unsure whether moderate-severe OSA treatment improves rates of cardiovascular events/death, (2) agreed that moderate-severe OSA treatment improves blood pressure in patients with hypertension and (3) mostly agreed that moderate-severe OSA treatment improves left ventricular function in patients with heart failure. Consensus of opinion was achieved for statements (1) and (2), but was narrowly missed for statement (3). The panel believed that findings from large-scale randomized trials indicate that treatment of moderate-severe OSA has not been established to improve cardiovascular event or morbidity/mortality rates. Strong evidence supports the ability of treatment to reduce blood pressure. Whilst many panel members believed that treatment improves left ventricular function, some were uncertain of the clinical significance of this secondary endpoint measure derived from lesser quality evidence.

Sections du résumé

BACKGROUND AND OBJECTIVE
Obstructive sleep apnoea (OSA) is a prevalent sleep disorder associated with increased cardiovascular morbidity and mortality. Whether treatment of OSA improves cardiovascular risk remains controversial. Our aim was to determine a consensus opinion of key sleep medicine stakeholder groups as to the cardiovascular benefits of treating moderate-severe OSA.
METHODS
A multidisciplinary panel was assembled from representatives from the Australasian Sleep Association, Sleep Health Foundation, Australasian Sleep Technologists Association, the Sleep Health Foundation Business Council and the Sleep Disorders Australia patient support group. Three statements reflecting areas of controversy related to cardiovascular benefits of OSA treatment were created. A modified RAND/UCLA appropriateness methodology was applied determining the panel's level of consensus and agreement with each statement.
RESULTS
Voting results indicated the panel: (1) remained unsure whether moderate-severe OSA treatment improves rates of cardiovascular events/death, (2) agreed that moderate-severe OSA treatment improves blood pressure in patients with hypertension and (3) mostly agreed that moderate-severe OSA treatment improves left ventricular function in patients with heart failure. Consensus of opinion was achieved for statements (1) and (2), but was narrowly missed for statement (3).
CONCLUSION
The panel believed that findings from large-scale randomized trials indicate that treatment of moderate-severe OSA has not been established to improve cardiovascular event or morbidity/mortality rates. Strong evidence supports the ability of treatment to reduce blood pressure. Whilst many panel members believed that treatment improves left ventricular function, some were uncertain of the clinical significance of this secondary endpoint measure derived from lesser quality evidence.

Identifiants

DOI: 10.1111/resp.13413 PMID: 30284745
pubmed: 30284745
doi: 10.1111/resp.13413
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

376-381

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2018 Asian Pacific Society of Respirology.

Auteurs

Shane A Landry (SA)

Department of Physiology, Monash University, Melbourne, VIC, Australia.
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia.
ORCID: 0000-0002-9041-3655

Siobhan Banks (S)

Behaviour-Brain-Body Research Centre, University of South Australia, Adelaide, SA, Australia.

Peter A Cistulli (PA)

Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
Charles Perkins Centre and Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

Garun S Hamilton (GS)

Monash Lung and Sleep, Monash Medical Centre, Melbourne, VIC, Australia.
School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
Monash Partners - Epworth, Melbourne, VIC, Australia.
ORCID: 0000-0002-1744-2839

Laure Héraud (L)

Air Liquide Healthcare, Sydney, NSW, Australia.

Kristina Kairaitis (K)

Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia.
Department of Respiratory and Sleep Medicine, Westmead Hospital, University of Sydney, Sydney, NSW, Australia.

Steven Lubke (S)

ResMed, Adelaide, SA, Australia.

Sutapa Mukherjee (S)

Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia.
Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.
ORCID: 0000-0001-5021-1648

Teanau Roebuck (T)

Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.

Joesph Soda (J)

Sleep Disorders Australia, Adelaide, SA, Australia.

Darren Umbers (D)

Philips Sleep and Respiratory Care, Adelaide, SA, Australia.

Shantha M W Rajaratnam (SMW)

School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia.

Darren Mansfield (D)

Monash Lung and Sleep, Monash Medical Centre, Melbourne, VIC, Australia.
Monash Partners - Epworth, Melbourne, VIC, Australia.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Pression sanguine › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Maladies cardiovasculaires › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation à pression positive › Ventilation en pression positive continue › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes de santé › Indicateurs d'état de santé › Acuité des besoins du patient › Indice de gravité de la maladie › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Maladies du système nerveux › Syndromes d'apnées du sommeil › Syndrome d'apnées obstructives du sommeil › A consensus opinion amongst stakeholders as to...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Fonction ventriculaire gauche › A consensus opinion amongst stakeholders as to...