Trajectories of CPAP termination and resumption: a French nationwide database analysis

Abstract

Rationale and aims: CPAP termination rates before 3 years as high as 50 % have been reported and are associated with a significantly higher risk of all-cause death. The objective of this study was to assess prevalence and determinants of CPAP resumption after a first CPAP termination and its impact on all-cause mortality.

Method: Data from the French national health insurance reimbursement system were analysed for all new adult CPAP users starting treatment in 2015 and 2016. Patients were grouped according to their CPAP treatment behaviours regarding CPAP continuation, termination or resumption. Multivariable analyses including propensity score approaches were conducted.

Results: From 344,969 patients included, 150,111 (43.5%) experienced a first CPAP termination in the 3 years following CPAP initiation. Among these, 27,212 (26%) were re-initiated on CPAP in the year following their first CPAP termination. At one year after resumption 65% were still continuing CPAP. Older age and a prescription for restarting CPAP given by a trained specialist (vs. a general practitioner) were associated with a lower risk of repeat CPAP termination after resumption. After propensity score matching, patients re-stopping their CPAP treatment after a first resumption had a higher one-year risk of all-cause mortality: HR: 1.61 [1.26-2.05], p<0.001.

Conclusion: A quarter of OSA patients who stop CPAP restart treatment during the year following the interruption. There is a beneficial effect associated with reduced mortality compared to those who again terminate CPAP. These long-term trajectories of CPAP termination and resumption deserve further investigation to propose specific care pathways and improve outcomes.