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. 2021 Mar 1;10(5):936.
doi: 10.3390/jcm10050936.

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

Jean-Louis Pépin  1 , Sébastien Bailly  1 , Pierre Rinder  2 , Dan Adler  3 , Daniel Szeftel  2 , Atul Malhotra  4 , Peter A Cistulli  5 , Adam Benjafield  6 , Florent Lavergne  7 , Anne Josseran  7 , Renaud Tamisier  1 , Pierre Hornus  2 , On Behalf Of The medXcloud Group
Affiliations

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

Jean-Louis Pépin et al. J Clin Med. .

Abstract

The nationwide claims data lake for sleep apnoea (ALASKA)-real-life data for understanding and increasing obstructive sleep apnea (OSA) quality of care study-investigated long-term continuous positive airway pressure (CPAP) termination rates, focusing on the contribution of comorbidities. The French national health insurance reimbursement system data for new CPAP users aged ≥18 years were analyzed. Innovative algorithms were used to determine the presence of specific comorbidities (hypertension, diabetes and chronic obstructive pulmonary disease (COPD)). Therapy termination was defined as cessation of CPAP reimbursements. A total of 480,000 patients were included (mean age 59.3 ± 13.6 years, 65.4% male). An amount of 50.7, 24.4 and 4.3% of patients, respectively, had hypertension, diabetes and COPD. Overall CPAP termination rates after 1, 2 and 3 years were 23.1, 37.1 and 47.7%, respectively. On multivariable analysis, age categories, female sex (1.09 (1.08-1.10) and COPD (1.12 (1.10-1.13)) and diabetes (1.18 (1.16-1.19)) were significantly associated with higher CPAP termination risk; patients with hypertension were more likely to continue using CPAP (hazard ratio 0.96 (95% confidence interval 0.95-0.97)). Therapy termination rates were highest in younger or older patients with ≥1 comorbidity. Comorbidities have an important influence on long-term CPAP continuation in patients with OSA.

Keywords: adherence; comorbidities; continuous positive airway pressure; obstructive sleep apnea; treatment.

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Conflict of interest statement

J.-L.P. has received lecture fees or conference traveling grants from ResMed, Perimetre, Philips, Fisher and Paykel, AstraZeneca, Jazz Pharmaceuticals, Agiradom and Teva and has received unrestricted research funding from ResMed, Philips, GlaxoSmithKline, Bioprojet, Fondation de la Recherche Medicale (Foundation for Medical Research), Direction de la Recherche Clinique du CHU de Grenoble (Research Branch Clinic CHU de Grenoble) and fond de dotation “Agir pour les Maladies Chroniques” (endowment fund “Acting for Chronic Diseases”). A.M. is funded by the NIH, reports income from Merck and Livanova related to medical education, and ResMed provided a philanthropic donation to UC San Diego. P.A.C. has an appointment to an endowed academic Chair at the University of Sydney that was established from ResMed funding, has received research support from ResMed, SomnoMed and Zephyr Sleep Technologies, and is a consultant to ResMed, SomnoMed, Zephyr Sleep Technologies and Signifier Medical Technologies. R.T. has received consulting fees from ResMed, Inspire, Navigant and Jazz Pharmaceuticals, lecture fees from Agiradom, Elivie, ResMed and Philips, conference travel grants from Agiradom, and unrestricted research grants from ResMed, Vitalaire, Philips, APMC foundation Direction de la recherche Clinique du CHU de Grenoble and inter-regional research university hospital group. A.B., F.L. and A.J. are employees of ResMed. P.R., D.S. and P.H. are employees of SEMEIA. S.B. and D.A. have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Probability of continuing continuous positive airway pressure (CPAP) therapy during follow-up in patient subgroups: (A) by age group; (B) by sex; (C) by comorbidities. COPD, chronic obstructive pulmonary disease; HTN, hypertension (log-rank test p < 0.01 for all comparisons).
Figure 1
Figure 1
Probability of continuing continuous positive airway pressure (CPAP) therapy during follow-up in patient subgroups: (A) by age group; (B) by sex; (C) by comorbidities. COPD, chronic obstructive pulmonary disease; HTN, hypertension (log-rank test p < 0.01 for all comparisons).
Figure 2
Figure 2
Balloon graph showing the risk of therapy termination in patient subgroups with different age group (years) and comorbidity combinations. COPD, chronic obstructive pulmonary disease; HR, hazard ratio; HTN, hypertension. The HR values reported in the balloon plot represent a graphical summary of the multivariable Cox model adjusted for age, sex and comorbidities. The reference patient in the multivariable model is a male patient without comorbidities aged 61–70 years. For the Cox model, the HR values are multiplicative after exponential transformation, so by multiplying the different HR values in the model, it is possible to depict the HR values for specific demographic and clinical scenarios.
See this image and copyright information in PMC

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