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Abstract
Background and aims The recurrence of obstructive sleep apnoea (OSA) after positive airway pressure (PAP) therapy termination has physiological consequences that may increase cardiovascular (CV) risk. We aimed to determine whether PAP termination is associated with an increased incidence of major adverse CV events (MACE) compared with adherent PAP continuation.
Methods Data from the Pays de la Loire Sleep Cohort were linked to the French national health insurance database to identify incident MACE (composite outcome of mortality, stroke and cardiac diseases), and CV active drug (lipid-lowering, antihypertensive and antiplatelet drugs, beta-blockers) adherence (medication possession ratio ≥80%). The association of PAP termination with MACE was evaluated using a time-dependent survival Cox model, with adjustment for confounders including CV active drug status.
Results After a median follow-up of 8 years, 969 of 4188 included patients (median age 58 years, 69.6% men) experienced MACE, 1485 had terminated PAP while 2703 continued PAP with at least 4 hours/night use. 38% of patients were adherent to all CV drugs in the PAP continuation group versus 28% in the PAP termination group (p<0.0001). After adjustment for confounders, PAP termination was associated with an increased risk of MACE (HR (95% CI): 1.39 (1.20 to 1.62); p<0.0001). PAP termination was not associated with incident heart failure and coronary artery disease.
Conclusions In this multicentre clinical-based cohort involving 4188 patients with OSA, PAP termination compared with adherent PAP continuation was associated with an increased risk of MACE. More research is needed to determine whether support programmes on PAP adherence could improve CV outcomes.
- Sleep apnoea
Data availability statement
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Footnotes
AS and CL are joint first authors.
Contributors AS, CL, WT, FGou, TP, SL, LL-V, PM, AB-T, SK, SB and FGag were substantially involved in the design of the study and critical revision of the paper for important intellectual content. AS, CL, SB and FGag were substantially involved in drafting the article. SB conducted statistical analyses. As a garanter of the study, FGag accept full responsability for the work and/or the conduct of the study. He had accessed and verified the study report and all underlying group-level data reported in this manuscript. All authors were substantially involved in data acquisition, data analysis or interpretation of data. All authors approved this final version of the article.
Funding This study was supported by a grant from the Institut de Recherche en Santé Respiratoire des Pays de la Loire (IRSR), Beaucouzé, France (no award/grant number). This funding body had no role in the design of the study and collection, analysis and interpretation of data or in writing the manuscript.
Competing interests FGag declares receipt of personal fees from AIR LIQUIDE SANTE, INSPIRE, BIOPROJET, RESMED and SEFAM outside the submitted work; payment for presentations from PHILIPS RESPIRONICS, JAZZ PHARMACEUTICAL, BIOPROJET, CIDELEC and RESMED, non-financial support from ASTEN SANTE outside the submitted work. WT received support from ASTEN for attending scientific meetings and payment from AstraZeneca for lectures. SL has declared links of interest with Bioprojet, Idorsia, Vifor Pharma France (consultant), Resmed, Philips, Bioprojet, Jazz Pharmaceuticals, Cidelec, SOS Oxygène, Vitalaire, Zambon (speaker’s fees), ISIS Médical, Bioprojet, Resmed, SOS Oxygène (invitation to scientific meetings) and Bioserenity France (paid employee from 2019 to 2021). CL reports payment or presentations from RESMED, outside the submitted work. AS has recently been hired by SEFAM and has had links with interest with SOS Oxygène, Philips Respironics, Nukute, Nyxah and Cidelec. The other authors have no interests to disclose.
Provenance and peer review Not commissioned; externally peer reviewed.
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