Frailty and Recurrent Cardiovascular Events in Patients With Obstructive Sleep Apnoea: The SAVE Study.

The majority of participants with OSA and established CVD were classified as frail at baseline.

• 2653 OSA participants were included with a mean frailty index (FI) of 0.290 (SD 0.125)
• 783 (29.5%) were classified as moderately frail (FI 0.211–0.310)
• 1006 (37.9%) were classified as severely frail (FI ≥ 0.311)
• Mean age was 61.3 (SD 7.8) years, and 507 (19.1%) were female
• Participants came from 89 clinical centres in seven countries

Severe frailty was associated with a significantly increased risk of the composite cardiovascular endpoint compared to those without frailty.

• Hazard ratio (HR) for composite cardiovascular endpoint in severely frail vs. nonfrail: 2.41 (95% CI, 1.88–3.11)
• Follow-up period averaged 3.7 years
• The Rockwood frailty index was used to categorize participants into nonfrail (FI ≤ 0.210), moderately frail (FI 0.211–0.310), and severely frail (FI ≥ 0.311)
• Cox proportional hazards models were used to assess associations

Severe frailty was associated with increased risks of individual cardiovascular outcomes including stroke, hospitalisation for unstable angina, all-cause mortality, and CVD death.

• Stroke: HR 2.40 (95% CI, 1.54–3.74)
• Hospitalisation for unstable angina: HR 2.94 (95% CI, 1.98–4.35)
• All-cause mortality: HR 1.77 (95% CI, 1.01–3.11)
• CVD death: HR 2.51 (95% CI, 1.13–5.60)
• All comparisons were between severely frail and nonfrail participants over a mean 3.7 years of follow-up

Frailty did not modify adherence to CPAP treatment across baseline frailty groups.

• There was a similar level of adherence to CPAP treatment across baseline frailty groups (p = 0.488)
• Participants were randomised to usual care plus CPAP treatment or usual care alone
• This was a post hoc analysis of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial (ClinicalTrials.gov: NCT00738179)

Frailty did not modify the effect of CPAP treatment on composite or individual recurrent cardiovascular events.

• There was no heterogeneity in the effect of CPAP treatment on composite and separate cardiovascular events across frailty groups
• Analysis was conducted over a mean follow-up of 3.7 years
• Cox proportional hazards models were used to assess associations of frailty index with cardiovascular outcomes