Sleep apnea–specific pulse-rate response, cardiovascular risk and response to positive airway pressure.

The pulse-rate response to sleep apneas and hypopneas (ΔHR) has been shown to be associated with cardiovascular (CV) risk in the general population and with response to positive airway pressure (PAP) in patients with coronary artery disease. We aimed to evaluate the association of ΔHR with incident Major Adverse CV Events (MACE) in patients with OSA (apnea-hypopnea index≥5) free of CV disease from two cohorts, the clinic-based Pays de la Loire Sleep Cohort (PLSC) and the HypnoLaus population-based cohort. The association of PAP adherence with MACE according to ΔHR was also assessed in PLSC. Cox models were used to assess the independent association between ΔHR derived from baseline sleep study pulse oximetry signal and incident MACE in 5,068 patients from PLSC and 1,329 patients from HypnoLaus. The association of PAP adherence (mean PAP use ≥4h/night) vs non-adherence (mean PAP use <4h/night or PAP termination) with MACE according to ΔHR was evaluated in 2,739 patients from PLSC. MACE occurred in 782 patients from PLSC (median [interquartile range] follow-up: 8.1 [5.8-10.7] years) and 88 individuals from HypnoLaus (7.5 [6.3-8.6] years). After adjustment for major confounders, subjects with high ΔHR were at increased risk of MACE in PLSC (≥16.3 bpm; n=1,267; HR: 1.24 [95% CI, 1.03–1.49], p=0.022) and in HypnoLaus (≥9.5 bpm; n=334; 1.72 [1.02–2.88], p=0.040) compared with those with midrange ΔHR. In PLSC, PAP adherence was associated with a reduction in MACE risk (HR, 0.64 [0.45–0.93]) in patients with ΔHR ≥15.7 bpm but not in those with ΔHR <5.7 bpm (p value for interaction =0.035). ΔHR could help identify OSA patients with increased CV risk likely to respond to PAP use.