CPAP resumption after a first termination and impact on all-cause mortality in France

Extract Obstructive sleep apnoea (OSA) is the most common form of sleep disordered breathing, affecting nearly one billion individuals aged 30–69 years worldwide [1]. OSA is characterised by recurrent complete or partial pharyngeal collapse during sleep, resulting in intermittent hypoxia, intrathoracic pressure swings and arousal from sleep [2, 3]. Symptoms occurring as a direct consequence of OSA include snoring, nonrestorative sleep and excessive daytime sleepiness [2]. In addition, OSA is a risk factor for a variety of cardiovascular and metabolic comorbidities, including hypertension, atrial fibrillation and diabetes mellitus [2–8]. Graphical abstract After initial therapy termination, resumption and continuation of continuous positive airway pressure (CPAP) therapy was associated with lower all-cause mortality risk than therapy resumption followed by a second termination. This highlights the value of offering a second CPAP trial. Background Continuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality versus therapy termination. However, there is a lack of data on the rates and impact of resuming CPAP in patients with obstructive sleep apnoea (OSA). This analysis determined the prevalence of CPAP resumption in the year after termination, characterised determinants of CPAP resumption, and examined the impact of CPAP resumption on all-cause mortality. Methods French national health insurance reimbursement system data for adults aged ≥18 years were used. CPAP prescription was identified by specific treatment codes. Patients who resumed CPAP after first therapy termination and continued to use CPAP for 1 year were matched with those who resumed CPAP then terminated therapy for a second time. Results Out of 103 091 individuals with a first CPAP termination, 26% resumed CPAP over the next 12 months, and 65% of these were still using CPAP 1 year later. Significant predictors of CPAP continuation after resumption included male sex, hypertension and CPAP prescription by a pulmonologist. In the matched population, the risk of all-cause death was 38% lower in individuals who continued using CPAP after therapy resumption versus those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48–0.79; p=0.0001). Conclusion These data suggest that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit. Tweetable abstract After initial therapy termination, resumption and continuation of CPAP therapy was associated with lower all-cause mortality risk than therapy resumption followed by a second termination. This highlights the value of offering a second CPAP trial. https://bit.ly/3N3RJcU