Pub Date : 2025-03-18DOI: 10.1016/s2213-2600(25)00047-5
Kamlesh Khunti, Rachael A Evans, Amitava Banerjee, Christina van der Feltz-Cornelis
No Abstract
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Pub Date : 2025-03-18DOI: 10.1016/s2213-2600(25)00002-5
Adam V Benjafield, Jean-Louis Pepin, Peter A Cistulli, Alison Wimms, Florent Lavergne, Fatima H Sert Kuniyoshi, Sibyl H Munson, Brendan Schuler, Shrikar Reddy Badikol, Kelly C Wolfe, Leslee Willes, Colleen Kelly, Tetyana Kendzerska, Dayna A Johnson, Raphael Heinzer, Chi-Hang Lee, Atul Malhotra
Background
Data regarding the effect of positive airway pressure (PAP) therapy for obstructive sleep apnoea (OSA) on all-cause mortality are inconsistent. We aimed to conduct a systematic review and meta-analysis to test the hypothesis that PAP therapy is associated with reduced all-cause and cardiovascular mortality in people with OSA.
Methods
For this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from database inception to Aug 22, 2023 (updated Sept 9, 2024), with no language or geographical restrictions. Reference lists of eligible studies and recent conference abstracts (2022–23) were also reviewed. We included outpatient studies (randomised controlled trials [RCTs] or confounder-adjusted, non-randomised controlled studies [NRCSs]) assessing the incidence of all-cause mortality, cardiovascular mortality, or both in adults (aged ≥18 years) with OSA who were treated versus not treated with PAP; other study types and studies that evaluated only PAP adherence were excluded. Abstracts of all retrieved publications were independently screened by two of three researchers (BS, SRB, and KCW), with disagreements resolved by adjudication from another researcher (SHM). The AutoLit feature of the Nested Knowledge platform was used for the review and data-extraction phases. We analysed each log-transformed hazard ratio (HR) and SE using a linear random-effects model to estimate overall HRs and 95% CIs. To evaluate the risk of bias, we used the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for NRCSs. This study was registered with PROSPERO, CRD42023456627.
Findings
Of 5484 records identified by our search, 435 were assessed for eligibility and 30 studies were included in the systematic review and meta-analysis (ten RCTs and 20 NRCSs). These studies included 1 175 615 participants, of whom 905 224 (77%) were male and 270 391 (23%) were female (SE 1·9), with a mean age of 59·5 (SE 1·4) years and a mean follow-up of 5·1 (0·5) years. The risk of bias was low to moderate. The risk of all-cause mortality (HR 0·63, 95% CI 0·56–0·72; p<0·0001) and cardiovascular mortality (0·45, 0·29–0·72; p<0·0001) was significantly lower in the PAP group than in the no-PAP group, and the clinically relevant benefit of PAP therapy increased with use.
Interpretation
Our results are consistent with a potentially beneficial effect of PAP therapy on all-cause and cardiovascular mortality in patients with OSA. Patients should be made aware of this effect of their treatment, which could result in greater acceptance of treatment initiation and greater adherence, leading to a higher likelihood of improved outcomes.
Funding
ResMed.
{"title":"Positive airway pressure therapy and all‐cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies","authors":"Adam V Benjafield, Jean-Louis Pepin, Peter A Cistulli, Alison Wimms, Florent Lavergne, Fatima H Sert Kuniyoshi, Sibyl H Munson, Brendan Schuler, Shrikar Reddy Badikol, Kelly C Wolfe, Leslee Willes, Colleen Kelly, Tetyana Kendzerska, Dayna A Johnson, Raphael Heinzer, Chi-Hang Lee, Atul Malhotra","doi":"10.1016/s2213-2600(25)00002-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00002-5","url":null,"abstract":"<h3>Background</h3>Data regarding the effect of positive airway pressure (PAP) therapy for obstructive sleep apnoea (OSA) on all-cause mortality are inconsistent. We aimed to conduct a systematic review and meta-analysis to test the hypothesis that PAP therapy is associated with reduced all-cause and cardiovascular mortality in people with OSA.<h3>Methods</h3>For this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from database inception to Aug 22, 2023 (updated Sept 9, 2024), with no language or geographical restrictions. Reference lists of eligible studies and recent conference abstracts (2022–23) were also reviewed. We included outpatient studies (randomised controlled trials [RCTs] or confounder-adjusted, non-randomised controlled studies [NRCSs]) assessing the incidence of all-cause mortality, cardiovascular mortality, or both in adults (aged ≥18 years) with OSA who were treated versus not treated with PAP; other study types and studies that evaluated only PAP adherence were excluded. Abstracts of all retrieved publications were independently screened by two of three researchers (BS, SRB, and KCW), with disagreements resolved by adjudication from another researcher (SHM). The AutoLit feature of the Nested Knowledge platform was used for the review and data-extraction phases. We analysed each log-transformed hazard ratio (HR) and SE using a linear random-effects model to estimate overall HRs and 95% CIs. To evaluate the risk of bias, we used the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for NRCSs. This study was registered with PROSPERO, CRD42023456627.<h3>Findings</h3>Of 5484 records identified by our search, 435 were assessed for eligibility and 30 studies were included in the systematic review and meta-analysis (ten RCTs and 20 NRCSs). These studies included 1 175 615 participants, of whom 905 224 (77%) were male and 270 391 (23%) were female (SE 1·9), with a mean age of 59·5 (SE 1·4) years and a mean follow-up of 5·1 (0·5) years. The risk of bias was low to moderate. The risk of all-cause mortality (HR 0·63, 95% CI 0·56–0·72; p<0·0001) and cardiovascular mortality (0·45, 0·29–0·72; p<0·0001) was significantly lower in the PAP group than in the no-PAP group, and the clinically relevant benefit of PAP therapy increased with use.<h3>Interpretation</h3>Our results are consistent with a potentially beneficial effect of PAP therapy on all-cause and cardiovascular mortality in patients with OSA. Patients should be made aware of this effect of their treatment, which could result in greater acceptance of treatment initiation and greater adherence, leading to a higher likelihood of improved outcomes.<h3>Funding</h3>ResMed.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"4 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/s2213-2600(25)00015-3
Ye Zhang, Virend K Somers, Xiangdong Tang
No Abstract
无摘要
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Pub Date : 2025-03-17DOI: 10.1016/s2213-2600(25)00008-6
Scott R DeBoer, Romergryko Geocadin
No Abstract
{"title":"Withdrawal of life sustaining therapies in patients with or without acute brain injury","authors":"Scott R DeBoer, Romergryko Geocadin","doi":"10.1016/s2213-2600(25)00008-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00008-6","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"16 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-17DOI: 10.1016/s2213-2600(24)00404-1
Shaurya Taran, Kuan Liu, Victoria A McCredie, Oscar Penuelas, Karen E A Burns, Fernando Frutos-Vivar, Damon C Scales, Niall D Ferguson, Jeffrey M Singh, Armaan K Malhotra, Neill K J Adhikari
Background
Many deaths in the intensive care unit (ICU) occur after a decision to withdraw or withhold life-sustaining therapies (WLSTs). We aimed to explore the differences in the incidence and timing of WLST between patients with and without acute brain injuries (ABIs).
Methods
We did a secondary analysis of two prospective, international studies that recruited patients who were invasively or non-invasively ventilated between 2004 and 2016 from 40 countries. ABI was defined as brain trauma, ischaemic stroke, intracranial haemorrhage, seizures, or meningitis–encephalitis. The comparator group included non-ABI conditions. Time to WLST was evaluated by use of cumulative incidence curves. Differences in WLST were analysed by use of multilevel logistic regression.
Findings
Between March 11, 2004, and Dec 17, 2016, we recruited 21 970 patients (16 791 in the WLST analysis), of whom 13 526 (61·6%) were male and 8444 (38·4%) were female and 2896 (13·2%) had ABI. WLST occurred in 2056 (12·2%) of 16 791 patients) and was more common in patients with ABI versus without (372 [17·0%] of 2191 vs 1684 [11·5%] of 14 600; risk difference 5·5%; 95% CI 3·8–7·1; odds ratio [OR] 2·42; 1·89–3·12). WLST decisions occurred earlier in patients with ABI versus patients without ABI (median, 4 days [IQR 2–9] versus 6 days [2–13] after ICU admission; absolute difference, 2 days; 95% CI 1–3). Findings were similar across different ABI subgroups, world regions, and cohort years. Variability among ICUs in WLST decisions for patients with ABI and patients without ABI was high (respectively, median OR, 3·04; 95% CI 2·54–3·67, and median OR 2·59; 2·38–2·78).
Interpretation
Our findings suggest that WLST decisions are significantly more common in patients with ABI versus patients without ABI and occur earlier in this group. The rationale for early WLST following ABI warrants further exploration, accounting for additional neurological factors that were not available in the present analysis.
Funding
Canadian Institutes of Health Research.
{"title":"Decisions to withdraw or withhold life-sustaining therapies in patients with and without acute brain injury: a secondary analysis of two prospective cohort studies","authors":"Shaurya Taran, Kuan Liu, Victoria A McCredie, Oscar Penuelas, Karen E A Burns, Fernando Frutos-Vivar, Damon C Scales, Niall D Ferguson, Jeffrey M Singh, Armaan K Malhotra, Neill K J Adhikari","doi":"10.1016/s2213-2600(24)00404-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00404-1","url":null,"abstract":"<h3>Background</h3>Many deaths in the intensive care unit (ICU) occur after a decision to withdraw or withhold life-sustaining therapies (WLSTs). We aimed to explore the differences in the incidence and timing of WLST between patients with and without acute brain injuries (ABIs).<h3>Methods</h3>We did a secondary analysis of two prospective, international studies that recruited patients who were invasively or non-invasively ventilated between 2004 and 2016 from 40 countries. ABI was defined as brain trauma, ischaemic stroke, intracranial haemorrhage, seizures, or meningitis–encephalitis. The comparator group included non-ABI conditions. Time to WLST was evaluated by use of cumulative incidence curves. Differences in WLST were analysed by use of multilevel logistic regression.<h3>Findings</h3>Between March 11, 2004, and Dec 17, 2016, we recruited 21 970 patients (16 791 in the WLST analysis), of whom 13 526 (61·6%) were male and 8444 (38·4%) were female and 2896 (13·2%) had ABI. WLST occurred in 2056 (12·2%) of 16 791 patients) and was more common in patients with ABI versus without (372 [17·0%] of 2191 <em>vs</em> 1684 [11·5%] of 14 600; risk difference 5·5%; 95% CI 3·8–7·1; odds ratio [OR] 2·42; 1·89–3·12). WLST decisions occurred earlier in patients with ABI versus patients without ABI (median, 4 days [IQR 2–9] versus 6 days [2–13] after ICU admission; absolute difference, 2 days; 95% CI 1–3). Findings were similar across different ABI subgroups, world regions, and cohort years. Variability among ICUs in WLST decisions for patients with ABI and patients without ABI was high (respectively, median OR, 3·04; 95% CI 2·54–3·67, and median OR 2·59; 2·38–2·78).<h3>Interpretation</h3>Our findings suggest that WLST decisions are significantly more common in patients with ABI versus patients without ABI and occur earlier in this group. The rationale for early WLST following ABI warrants further exploration, accounting for additional neurological factors that were not available in the present analysis.<h3>Funding</h3>Canadian Institutes of Health Research.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"18 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-04DOI: 10.1016/s2213-2600(25)00010-4
Hoppe JE, Kasi AS, Pittman JE, et al. Vanzacaftor–tezacaftor–deutivacaftor for children aged 6–11 years with cystic fibrosis (RIDGELINE Trial VX21-121-105): an analysis from a single-arm, phase 3 trial. Lancet Respir Med 2025; 13: 244–55—The author line of this Article should have included the VX21-121-105 Study Group. This correction has been made to the online version as of March 4, 2025, and the printed version is correct.
{"title":"Correction to Lancet Respir Med 2025; 13: 244–55","authors":"","doi":"10.1016/s2213-2600(25)00010-4","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00010-4","url":null,"abstract":"<em>Hoppe JE, Kasi AS, Pittman JE, et al. Vanzacaftor–tezacaftor–deutivacaftor for children aged 6–11 years with cystic fibrosis (RIDGELINE Trial VX21-121-105): an analysis from a single-arm, phase 3 trial.</em> Lancet Respir Med <em>2025;</em> 13: <em>244–55</em>—The author line of this Article should have included the VX21-121-105 Study Group. This correction has been made to the online version as of March 4, 2025, and the printed version is correct.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"6 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-04DOI: 10.1016/s2213-2600(25)00006-2
Nicolas Roche, Kerri A Johannson
No Abstract
{"title":"Home-based monitoring in chronic respiratory diseases: in search of Panacea","authors":"Nicolas Roche, Kerri A Johannson","doi":"10.1016/s2213-2600(25)00006-2","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00006-2","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"3 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-04DOI: 10.1016/s2213-2600(25)00011-6
Keating C, Yonker LM, Vermeulen F, et al. Vanzacaftor–tezacaftor–deutivacaftor versus elexacaftor–tezacaftor–ivacaftor in individuals with cystic fibrosis aged 12 years and older (SKYLINE Trials VX20-121-102 and VX20-121-103): results from two randomised, active-controlled, phase 3 trials. Lancet Respir Med 2025; 13: 256–71—The author line of this Article should have included the VX20-121-102 Study Group and the VX20-121-103 Study Group. This correction has been made to the online version as of March 4, 2025, and the printed version is correct.
{"title":"Correction to Lancet Respir Med 2025; 13: 256–71","authors":"","doi":"10.1016/s2213-2600(25)00011-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00011-6","url":null,"abstract":"<em>Keating C, Yonker LM, Vermeulen F, et al. Vanzacaftor–tezacaftor–deutivacaftor versus elexacaftor–tezacaftor–ivacaftor in individuals with cystic fibrosis aged 12 years and older (SKYLINE Trials VX20-121-102 and VX20-121-103): results from two randomised, active-controlled, phase 3 trials.</em> Lancet Respir Med <em>2025;</em> 13: <em>256–71</em>—The author line of this Article should have included the VX20-121-102 Study Group and the VX20-121-103 Study Group. This correction has been made to the online version as of March 4, 2025, and the printed version is correct.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"19 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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