Positive Airway Pressure Adherence, Mortality, and Cardiovascular Events in Patients with Sleep Apnea
Chloé Gervès‐Pinquié, Sébastien Bailly, François Goupil, Thierry Pigeanne, Sandrine Launois, Laurène Leclair‐Visonneau, Philippe Masson, Acya Bizieux‐Thaminy, Margaux Blanchard, Abdelkebir Sabil, Dany Jaffuel, Jean-Louis Racineux, Wojciech Trzépizur, Frédéric Gagnadoux
Abstract
Abstract Rationale Randomized controlled trials showed no effect of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on cardiovascular (CV) risk. However, patient selection and low PAP adherence preclude the generalization of their data to clinical samples. Objectives To evaluate the association between hours of PAP use, mortality, and CV morbidity in real-life conditions. Methods Data from the Pays de la Loire Cohort were linked to health administrative data to identify incident major adverse cardiovascular events (MACEs; a composite outcome of mortality, stroke, and cardiac diseases) in patients with OSA who were prescribed PAP. Cox proportional hazards analyses were conducted to evaluate the association between MACEs and quartiles of average daily PAP use over the study period. Measurements and Main Results After a median follow-up of 6.6 years, 961 of 5,138 patients experienced MACEs. Considering nonadherent patients (0–4 h/night) as the reference group, adjusted hazard ratios (95% confidence intervals) for MACEs were 0.87 (0.73–1.04) for the 4–6 h/night group, 0.75 (0.62–0.92) for the 6–7 h/night group, and 0.78 (0.65–0.93) for the ⩾7 h/night group (P = 0.0130). Sensitivity analyses using causal inference approaches confirmed the association of PAP use with MACEs. The association was stronger in male patients (P value for interaction = 0.0004), patients without overt CV disease at diagnosis (P < 0.0001), and those belonging to the excessively sleepy symptom subtype (P = 0.060). Conclusions These real-life clinical data demonstrate a dose–response relationship between PAP adherence and incident MACEs in OSA. Patient support programs may help improve PAP adherence and CV outcomes in patients with OSA.