Despite increasing evidence of a link between obstructive sleep apnea (OSA) and cardiovascular (CV) disease RCTs of OSA therapy focussing on hard CV endpoints are lacking. SAVE is an international, multicentre RCT of CPAP therapy plus standard care vs standard care alone in patients with CV disease and co-existing OSA which is designed to fill this evidence gap. Other design parameters are: n = 5000; a 1-week run-in phase with sham CPAP to exclude those unable to accept CPAP; follow-up of 4 years; composite CV endpoint of sudden death, MI, stroke, unstable angina, TIA and heart failure. The trial began in Australia and China in December 2008. To date 54 sites have randomised 433 patients (73 Australia, 360 China). 72% of patients had a baseline Epworth Sleepiness Score (ESS) ≤ 10. Average recruitment during the roll-out phase has been 1 patient/site/month. CPAP adherence at 1, 3 and 6 months was 5.0 ± 0.12 (n = 154), 4.9 ± 0.14 (n = 117) and 4.7 ± 0.20 (n = 63) h/night and was the same in sleepy (ESS > 10) and non-sleepy patients (4.9 h/night vs 5.0 h/night). In the first year 12 (3%) patients withdrew and 3 of 201 (1.5%) in the control group crossed-over to CPAP. Conclusions. There has been widespread acceptance of the trial by clinicians and patients in China and Australia/NZ. Recruitment rates are relatively low due to the complexity of screening but CPAP adherence is high and patient drop out and cross-over rates are low.

Little is known about chronic obstructive pulmonary disease (COPD) in Chinese nonsmokers. The present study aimed to investigate the profiles of COPD among nonsmokers based on the Chinese Epidemiological Survey of COPD (CESCOPD).In the CESCOPD, 20,245 subjects aged 40 yrs or older were interviewed with questionnaires and spirometry tests. Subjects with a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio of <0.70 were identified as having COPD. Data of 12,471 nonsmokers and 1,024 smoking COPD patients were analysed in the current study.The overall prevalence of COPD among nonsmokers was 5.2% (95% confidence interval 4.8-5.6). Being male, of advanced age, lower body mass index (BMI) and lower educational level, having exposure to environmental tobacco smoke, coal and/or biomass smoke, poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough were all independently associated with a higher risk of having COPD among nonsmokers. Nonsmokers with respiratory symptoms without airflow limitation showed a somewhat different pattern of risk factors. Nonsmokers with COPD were less likely to present with chronic productive coughs and lower BMI, while more likely to have received a physician diagnosis of asthma and respiratory diseases in childhood, than smokers with COPD.Chronic obstructive pulmonary disease is prevalent among Chinese nonsmokers, and nonsmoking chronic obstructive pulmonary disease may have different profiles from smoking chronic obstructive pulmonary disease.