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

• Published in: The European respiratory journal Vol. 63; no. 2; p. 2301171
• Main Authors: Pépin, Jean-Louis, Tamisier, Renaud, Benjafield, Adam V., Rinder, Pierre, Lavergne, Florent, Josseran, Anne, Sinel-Boucher, Paul, Cistulli, Peter A., Malhotra, Atul, Hornus, Pierre, Bailly, Sébastien
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society 01.02.2024
• Subjects: Life Sciences; Original s
• ISSN: 0903-1936; 1399-3003; 1399-3003
• DOI: 10.1183/13993003.01171-2023

Continuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality 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. 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. 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 those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48-0.79; p=0.0001). 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.