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, -0·2-2·1) 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.
