Randomized Controlled Trial

. 2025 Jul 28;23(1):442.

doi: 10.1186/s12916-025-04279-5.

Healthy lifestyle factors and recurrent cardiovascular events in patients with OSA: the SAVE study

Shoujiang You^#¹, Danni Zheng^#², Kelly A Loffler³, R Doug McEvoy³, Qiang Li², Yuanming Luo⁴, Ferran Barbé⁵, Qiong Ou⁶, Rui Chen⁷, Chun-Feng Liu¹, Yongjun Cao¹, Xia Wang², Geraldo Lorenzi-Filho⁸, Manjari Tripathi⁹, Craig S Anderson^{10

11

12}; SAVE Investigators

Affiliations

¹ Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China.
² The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Missenden Road, PO Box M201, Sydney, NSW, 2050, Australia.
³ Flinders Health and Medical Research Institute, College of Medicine and Public Health,, Flinders University, Adelaide, Australia.
⁴ The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, People's Republic of China.
⁵ Respiratory Department, Centro de Investigacio´n Biome´dica en Red de Enfermedades Respiratorias, Institutde Recerca Biome`dica de Lleida, Madrid, Spain.
⁶ Sleep Center, Respiratory and Critical Medical Department, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510000, People's Republic of China.
⁷ Department of Respiratory, The Second Affiliated Hospital of Soochow University, Suzhou, China.
⁸ Instituto do Coracao (Incor) and Hospital Universitario, Sao Paulo, Brazil.
⁹ Neurology Department, All India Institute of Medical Sciences, Delhi, India.
¹⁰ The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Missenden Road, PO Box M201, Sydney, NSW, 2050, Australia. canderson@georgeinstitute.org.au.
¹¹ The Institute of Science and Technology for Brain-inspired Research, Fudan University, Shanghai, China. canderson@georgeinstitute.org.au.
¹² Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia. canderson@georgeinstitute.org.au.

^# Contributed equally.

PMID: 40721783
PMCID: PMC12306100
DOI: 10.1186/s12916-025-04279-5

Randomized Controlled Trial

Healthy lifestyle factors and recurrent cardiovascular events in patients with OSA: the SAVE study

Shoujiang You et al. BMC Med. 2025.

. 2025 Jul 28;23(1):442.

doi: 10.1186/s12916-025-04279-5.

Authors

Affiliations

¹ Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China.
² The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Missenden Road, PO Box M201, Sydney, NSW, 2050, Australia.
³ Flinders Health and Medical Research Institute, College of Medicine and Public Health,, Flinders University, Adelaide, Australia.
⁴ The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, People's Republic of China.
⁵ Respiratory Department, Centro de Investigacio´n Biome´dica en Red de Enfermedades Respiratorias, Institutde Recerca Biome`dica de Lleida, Madrid, Spain.
⁶ Sleep Center, Respiratory and Critical Medical Department, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510000, People's Republic of China.
⁷ Department of Respiratory, The Second Affiliated Hospital of Soochow University, Suzhou, China.
⁸ Instituto do Coracao (Incor) and Hospital Universitario, Sao Paulo, Brazil.
⁹ Neurology Department, All India Institute of Medical Sciences, Delhi, India.
¹⁰ The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Missenden Road, PO Box M201, Sydney, NSW, 2050, Australia. canderson@georgeinstitute.org.au.
¹¹ The Institute of Science and Technology for Brain-inspired Research, Fudan University, Shanghai, China. canderson@georgeinstitute.org.au.
¹² Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia. canderson@georgeinstitute.org.au.

^# Contributed equally.

PMID: 40721783
PMCID: PMC12306100
DOI: 10.1186/s12916-025-04279-5

Abstract

Background: The extent to which healthy lifestyle factors influence recurrent cardiovascular events in obstructive sleep apnea (OSA) patients is uncertain. To evaluate the association between adherence to baseline healthy lifestyle and the risk of recurrent cardiovascular events in OSA patients.

Methods: Post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) study involving participants with moderate-to-severe OSA and established cardiovascular disease (CVD) who were randomized to continuous positive airway pressure (CPAP) plus usual care or usual care alone. We assigned a score ranging from 0 to 4 for each participant, based on the number of criteria met for the baseline health lifestyle factors of non-smoking, moderate-to-vigorous physical activity, ideal waist/hip ratio, and low-to-moderate alcohol consumption.

Results: In total, 2659 OSA patients with established CVD were included. The adjusted hazard ratios for participants with ≥ 2 healthy lifestyle factors compared with none were 0.64 (95% confidence interval [CI] 0.50-0.84) for composite cardiovascular events, 0.46 (0.28-0.74) for stroke, 0.65 (0.45-0.96) for hospitalization for unstable angina, 0.35 (0.19-0.63) for all-cause mortality, and 0.36 (0.16-0.79) for CVD death during a mean follow-up of 3.7 years. Each increment in healthy lifestyle factor score was associated with reduced risk of composite and separate cardiovascular events. A trend was found showing greater CPAP treatment benefit in those with more baseline healthy lifestyle for myocardial infarction and all-cause mortality; however, it did not reach statistical significance.

Conclusions: Greater adherence to an overall baseline healthy lifestyle is significantly associated with a lower risk of recurrent composite cardiovascular events in OSA patients with established CVD.

Keywords: Healthy lifestyle factors; Obstructive sleep apnea; Predict; Recurrent cardiovascular events; SAVE.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Local institutional review boards or independent ethics committees at recruiting sites approved the protocol, and all participants provided written informed consent. Consent for publication : Not applicable. Competing interests: Dr. You holds the National Natural Science Foundation of China (82471226), Discipline Construction Program of the Second Affiliated Hospital of Soochow University (XKTJ-RC202412), Jiangsu Provincial Medical Key Discipline (ZDXK202217) and the 6th Jiangsu Province 333 High Level Talents Training Project. Dr. Wang holds an investigator grant from the National Health and Medical Research Council (NHMRC) of Australia; Dr. Ferran Barbé is supported by the ICREA Academia program from Generalitat de Catalunya. Dr. Anderson holds a NHMRC Senior Investigator Fellowship and reports grant funding from NHMRC, Penumbra, and Takeda China. The other authors have nothing to disclose.

Figures

**Fig. 1**
Kaplan–Meier curves A Composite cardiovascular events; (B) stroke; (C) myocardial infarction; (D) hospitalization for unstable angina; (E) all-cause mortality; (F) CVD death. CVD indicates cardiovascular disease

**Fig. 2**
HRs (95% CIs) of CPAP treatment effect according to the overall healthy lifestyle factors in SAVE CPAP indicates continuous positive airway pressure; SAVE Sleep Apnea Cardiovascular Endpoints

See this image and copyright information in PMC

References

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Healthy lifestyle factors and recurrent cardiovascular events in patients with OSA: the SAVE study

Affiliations

Healthy lifestyle factors and recurrent cardiovascular events in patients with OSA: the SAVE study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous