Real-world status of continuous positive airway pressure (CPAP) persistence in patients with sleep apnea syndrome (SAS): a retrospective longitudinal study of administrative claims data in Japan.

Abstract

Purpose: To investigate the real-world status of continuous positive airway pressure (CPAP) persistence in patients with sleep apnea syndrome (SAS) using administrative claims data in Japan.

Methods: We designed a retrospective longitudinal study using administrative claims and medical check-up data collected from April 2014 to February 2022. We identified patients newly starting CPAP therapy as their first-line SAS treatment, and assessed patient characteristics, CPAP persistence rates, predictors of CPAP discontinuation, and second-line therapy options.

Results: The analysis population (n = 13,007) was 76.2% male, and the mean age (± standard deviation) was 64.0 ± 15.0 years. CPAP persistence rates were 90.1% at 90 days, 77.1% at one year, 70.3% at two years, and 66.5% at three years. More discontinuation was noted in patients aged 18 to 44 (adjusted hazard ratio [95% confidence interval]: 1.27 [1.13-1.42]) and ≥ 65 (65-74 years, 1.18 [1.07-1.30]; ≥75 years, 1.59 [1.43-1.76]) than in those aged 45 to 64. Comorbidities of dementia (1.47 [1.25-1.73]), insomnia (1.26 [1.16-1.36]), and restless legs syndrome (RLS, 1.60 [1.16-2.23]) were also associated with more discontinuation. Testing with a Type 3 portable monitor (1.31 [1.21-1.42]), or no record of sleep testing before therapy (1.21 [1.09-1.36]), tended to be associated with more discontinuation than polysomnography. CPAP therapy starting in 2020 (0.72 [0.63-0.82]) and 2021 (0.63 [0.46-0.85]) resulted in better persistence than that starting in 2016. Only 6.1% of patients received second-line therapy after CPAP discontinuation.

Conclusions: CPAP therapy was continued for at least a year by about 80% of patients. Because second-line therapies are rarely implemented, efforts are needed to ensure CPAP persistence by considering the factors that influence it. It is also crucial to raise awareness of alternative therapies.

Registration number: NA.