Long-term CPAP therapy boosts survival in obstructive sleep apnoea

Among obstructive sleep apnoea (OSA) patients treated in a real-world setting, those who persist with continuous positive airway pressure (CPAP) therapy may fare better in terms of mortality risk than those who terminate CPAP within the first year of treatment, a study has found.

The study used data from the French national health insurance reimbursement system database and included a propensity score-matched cohort of 88,007 patients who terminated CPAP therapy in the first year and 88,007 patients who continued to use CPAP. The mean age of the population overall was 60 years, and 64 percent were male.

Over a 3-year observation period, more patients in the termination group died than in the continuation group (3.6 percent vs 2.3 percent). On multivariable Cox analysis, continued use of CPAP was associated with about a 40-percent lower risk of all-cause death (hazard ratio [HR], 0.61, 95 percent confidence interval [CI], 0.57–0.65; p<0.01).

The lower risk of death in the continuation group was driven by a significantly lower incidence of heart failure relative to the termination group (HR, 0.77, 95 percent CI, 0.71–0.82; p<0.01). Moreover, there was a trend towards a lower risk of hospitalizations for diabetes in the continuation group (p=0.06).

Results of a sensitivity analysis confirmed and strengthened the study findings, showing that there was a 27-percent reduction in all-cause mortality in patients who continued vs terminated CPAP.

More work is needed to establish the impact of CPAP on specific causes of death, as well as to determine the relationship between hours of CPAP usage and mortality benefit.