CPAP Adherence, Mortality, and Progression-Free Survival in Interstitial Lung Disease and OSA

Abstract

OSA, a common comorbidity in interstitial lung disease (ILD), could contribute to a worsened course if untreated. It is unclear if adherence to CPAP therapy improves outcomes. Does adherence to CPAP therapy improve outcomes in patients with concurrent interstitial lung disease and OSA? We conducted a 10-year retrospective observational multicenter cohort study, assessing adult patients with ILD who had undergone polysomnography. Subjects were categorized based on OSA severity into no/mild OSA (apnea-hypopnea index score< 15) or moderate/severe OSA (apnea-hypopnea index score≥ 15). All subjects prescribed and adherent to CPAP were deemed to have treated OSA. Cox regression models were used to examine the association of OSA severity and CPAP adherence with all-cause mortality risk and progression-free survival (PFS). Of 160 subjects that met inclusion criteria, 131 had OSA and were prescribed CPAP. Sixty-six patients (41%) had no/mild untreated OSA, 51 (32%) had moderate/severe untreated OSA, and 43 (27%) had treated OSA. Subjects with no/mild untreated OSA did not differ from those with moderate/severe untreated OSA in mean survival time (127 ± 56 vs138 ± 93months, respectively; P= .61) and crude mortality rate (2.9 per 100 person-years vs2.9 per 100 person-years, respectively; P= .60). Adherence to CPAP was not associated with improvement in all-cause mortality risk (hazard ratio [HR], 1.1; 95%CI, 0.4-2.9; P= .79) or PFS (HR, 0.9; 95%CI, 0.5-1.5; P= .66) compared with those that were nonadherent or untreated. Among subjects requiring supplemental oxygen, those adherent to CPAP had improved PFS (HR, 0.3; 95%CI, 0.1-0.9; P= .03) compared with nonadherent or untreated subjects. Neither OSA severity nor adherence to CPAP was associated with improved outcomes in patients with ILD except those requiring supplemental oxygen.