Impact of beta-blockers on mortality and cardiovascular disease outcomes in patients with obstructive sleep apnoea: a population-based cohort study in target trial emulation framework

Anthony Chen (Lead / Corresponding author), Chengsheng Ju (Lead / Corresponding author), Isla S. Mackenzie, Thomas M. MacDonald, Allan D. Struthers, Li Wei, Kenneth K.C. Man (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
52 Downloads (Pure)

Abstract

Background: There is no real-world evidence regarding the association between beta-blocker use and mortality or cardiovascular outcomes in patients with obstructive sleep apnoea (OSA). We aimed to investigate the impact of beta-blocker use on all-cause mortality and cardiovascular diseases (CVDs) in patients with OSA. 

Methods: We conducted a target trial emulation study of 37,581 patients with newly diagnosed OSA from 1st January 2000 to 30th November 2021 using the IMRD-UK database (formerly known as the THIN database). We compared the treatment strategies of initiating beta-blocker treatment within one year versus non-beta-blocker treatment through the method of clone-censor-weight. Covariates, including patients’ demographics, lifestyle, comorbidities, and recent medications, were measured and controlled. Patients were followed up for all-cause mortality or composite CVD outcomes (angina, myocardial infarction, stroke/transient ischaemic attack, heart failure, or atrial fibrillation). We estimated the five-year absolute risks, risk differences and risk ratio with 95% confidence intervals (CIs) with standardised, weighted pooled logistic regression, which is a discrete-time hazard model for survival analysis. Several sensitivity analyses were performed, including multiple imputation addressing the missing data. 

Findings: The median follow-up time was 4.1 (interquartile range, 1.9–7.8) years. The five-year absolute risk of all-cause mortality and CVD outcomes were 4.9% (95% CI, 3.8–6.0) and 13.0% (95% CI, 11.4–15.0) among beta-blocker users, and 4.0% (95% CI, 3.8–4.2) and 9.4% (95% CI, 9.1–9.7) among non-beta-blocker users, respectively. The five-year absolute risk difference and risk ratio between the two groups for all-cause mortality and CVD outcomes were 0.9% (95% CI, −0.2 to 2.1) and 1.22 (95% CI, 0.96–1.54), and 3.5% (95% CI, 2.1–5.5) and 1.37 (95% CI, 1.22–1.62), respectively. Findings were consistent across the sensitivity analyses. 

Interpretation: Beta-blocker treatment was associated with an increased risk of CVD and a trend for an increased risk of mortality among patients with OSA. Further studies are needed to confirm our findings. 

Funding: Innovation and Technology Commission of the Hong Kong Special Administration Region Government.

Original languageEnglish
Article number100715
Number of pages9
JournalThe Lancet Regional Health - Europe
Volume33
Early online date4 Aug 2023
DOIs
Publication statusPublished - Oct 2023

Keywords

  • Beta-blocker
  • Cohort study
  • Obstructive sleep apnoea
  • Trial emulation

ASJC Scopus subject areas

  • Internal Medicine
  • Oncology
  • Health Policy

Fingerprint

Dive into the research topics of 'Impact of beta-blockers on mortality and cardiovascular disease outcomes in patients with obstructive sleep apnoea: a population-based cohort study in target trial emulation framework'. Together they form a unique fingerprint.

Cite this