Factors Associated with Residual Events in CPAP-Treated Sleep Apnea: Data from a Large French National Database

Introduction & background: Residual events during CPAP contribute to increase treatment drop-outs. Clinical scenarios triggering residual events during CPAP use are poorly described. Aims & objectives: Underlying comorbidities, especially cardiovascular diseases, lifestyle factors, OSA characteristics at baseline and type of mask are suggested as potential contributors. Methods: Patients from the prospective national French sleep apnea registry with apnea-hypopnea index (AHI) = 15/h and CPAP indication were included. A logistic regression analysis was used to identify factors associated with the probability of exhibiting a residual AHI > 5/h whilst on CPAP. Results: 12,285 OSA patients predominantly men (N=8715, 70.9%), middle aged (median [IQR]: 58.2 [49.8;66.1] years) and obese (median body mass index: 31.3 [27.7;35.6] kg/m²) were included. Most had an AHI=5/h (N=9,573, 77.9%) versus 22.1% exhibited an AHI>5/hour. The latter group was significantly less adherent to CPAP (5.75 [4.01;7.00] vs 6.00 [4.53;7.00] h/night). In multivariable analysis, factors associated with a high residual AHI were male gender, age and sedentary lifestyle, OSA severity, cardiovascular comorbidities and interface (orofacial versus nasal mask: OR = 2.15 [CI: 1.95;2.37]). Conclusions: The knowledge of at-risk clinical scenarios predicting more frequent residual events will help in the timely provision of personalized care including type of PAP therapy, attention to comorbidity care and interfacechoice