Associations between clinical or polysomnographic features and the risk of continuous positive airway pressure therapy termination in patients with obstructive sleep apnea: a 5-year cohort study.

Background: Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA). Despite CPAP recognized benefits, the 3-year CPAP termination rate in France is 47.7 %, with sex, age, and comorbidities identified as significant predictors of therapy termination. The contribution of symptoms, OSA severity and objective sleep parameters to CPAP termination remains to be investigated.

Methods: This single-center study used real-life data from a tertiary university for patients diagnosed with OSA and started on CPAP. Data were prospectively collected and linked to CPAP telemonitoring data from a single healthcare provider. CPAP termination was defined as the date when the device was returned to the healthcare provider by the patient.

Results: A total of 637 patients were included. Overall CPAP termination rates at 1, 3 and 5 years were 17.1 %, 26.8 % and 28.9 % respectively. On multivariable analysis CPAP continuation was significantly associated with male sex (hazard ratio [95 % confidence interval] 0.71 [0.52-0.97]; p = 0.03), OSA severity (severe vs. mild: 0.46 [0.25-0.86]; p < 0.001; severe vs. moderate: 0.57 [0.42-0.77]; p < 0.001) and longer total sleep time at diagnosis (0.99 [0.96-1.0]; p = 0.049). CPAP termination was significantly associated with a higher mean oxygen saturation (1.20 [1.10-1.31]; p < 0.001).

Conclusions: Clinical and polysomnographic phenotyping is useful in risk stratification for prediction of CPAP termination. Sleep quality metrics at diagnosis are among the key predictors of CPAP termination and should inform the personalization of follow-up management pathways.