Chen, Anthony

Ju, Chengsheng

Macdonald, Thomas M

Mackenzie, Isla S

Man, Kenneth KC

Struthers, Allan D

Wei, Li

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 allcause mortality and CVD outcomes were 4.9% (95% CI, 3.8–6.0) and 13.0% (95% CI, 11.4–15.0) among betablocker 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

UCL Discovery

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

https://discovery.ucl.ac.uk/id/eprint/10174272/

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

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