BACKGROUND Diuretics have been reported as effective for reducing obstructive sleep apnea (OSA) severity by preventing fluid retention and reducing rostral fluid shift. The benefit of diuretics might vary depending upon the OSA clinical phenotype and comorbidities. To test this hypothesis, we conducted a propensity score-matched cohort analysis of data from the French national sleep apnea registry "Observatoire Sommeil de la Fédération de Pneumologie" (OSFP). METHODS A propensity score analysis was used to determine the impact of diuretics on OSA severity. Matching (ratio 1:4) was performed by using a 0.1 collider for the propensity score. Severe OSA was defined as an apnea-hypopnea index (AHI) > 30 events/h and the usefulness of diuretics was assessed using a logistic regression model. RESULTS The 69,564 OSA patients studied in the OSFP prospective observational cohort had a median age of 56.9 years [Interquartile range (IQR): 47.4; 65.6], 67% were men, and the median AHI was 28 [14; 43] events/h. Among them, 9,783 (14.1%) were treated with diuretics. Diuretics reduced OSA severity in overweight or moderately obese patients (p=0.03) and in patients with hypertension (p<0.01), particularly in hypertensives with a body mass index between 25 and 35 kg/m2 (p<0.01). Diuretics had no significant effect on OSA severity in patients with self-reported low physical activity or heart failure. CONCLUSIONS Diuretics appear to have a positive impact on OSA severity in overweight or moderately obese patients with hypertension. A prospective study is needed to confirm that diuretics are of interest in combined therapies for hypertensive patients with OSA.

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谁可以从 OSA 中的利尿剂中受益？倾向得分匹配观察性研究

背景 已报道利尿剂通过防止体液潴留和减少嘴部液体转移可有效降低阻塞性睡眠呼吸暂停 (OSA) 的严重程度。利尿剂的益处可能因 OSA 临床表型和合并症而异。为了验证这一假设，我们对来自法国国家睡眠呼吸暂停登记处“Observatoire Sommeil de la Fédération de Pneumologie”（OSFP）的数据进行了倾向评分匹配的队列分析。方法 倾向评分分析用于确定利尿剂对 OSA 严重程度的影响。匹配（比例 1:4）是通过使用 0.1 碰撞器的倾向得分进行的。重度 OSA 定义为呼吸暂停低通气指数 (AHI) > 30 个事件/小时，使用逻辑回归模型评估利尿剂的有效性。结果 69, 在 OSFP 前瞻性观察队列中研究的 564 名 OSA 患者的中位年龄为 56.9 岁 [四分位距 (IQR)：47.4；65.6]，67% 为男性，中位 AHI 为 28 [14; 43] 事件/小时。其中，9,783（14.1%）例使用利尿剂治疗。利尿剂可降低超重或中度肥胖患者 (p=0.03) 和高血压患者 (p<0.01) 的 OSA 严重程度，尤其是体重指数在 25 至 35 kg/m2 之间的高血压患者 (p<0.01)。对于自我报告的低体力活动或心力衰竭的患者，利尿剂对 OSA 的严重程度没有显着影响。结论 利尿剂似乎对超重或中度肥胖的高血压患者的 OSA 严重程度有积极影响。