Low long-term mortality in patients with sleep apnoea and positive airway pressure therapy: analysis of a large German healthcare database

H Woehrle,M Arzt,P Young,O Oldenburg,B Libutzki,C Bischoff-Everding,J H Ficker,I Fietze,C Schoebel

doi:10.1007/s11818-020-00259-4

Abstract

Abstract Background There are limited data on long-term mortality in sleep apnoea (SA) patients with and without positive airway pressure (PAP) therapy. This retrospective cohort study investigated long-term hospitalisation and mortality rates in SA patients from a German statutory health insurance (SHI) database who did versus did not receive PAP therapy. Methods Patients had continuous insurance coverage from 01 January 2008 to 31 December 2013, complete medical records and ≥1 SA-related diagnosis in 2009. Those receiving PAP were matched with a control group not treated with PAP. Outcomes (hospitalisations including stays in the sleep laboratory) were compared between groups the year prior to and the 4 years after SA diagnosis. Mortality was assessed in the 4 years after SA diagnosis. Results 2176 PAP therapy recipients were matched with 2176 controls. The PAP group had a higher rate of hospitalisation in the year before SA diagnosis than the control group (80.2% vs. 26.6%; p = 0.0016). After diagnosis, the PAP group had a higher hospitalisation rate only in year 1 (p < 0.05), and average length of stay per hospitalisation was lower in the PAP group (p < 0.05 vs. control at years 1, 2 and 4). Cumulative all-cause mortality after year 3 (3.4% vs. 4.6%; p = 0.0287) and after year 4 (4.8% vs. 6.5%; p = 0.0175) was significantly lower in SA patients receiving PAP versus controls (relative risk reduction for death after 4 years: 25.5%). Conclusion This real-world cohort study showed an association between long-term PAP therapy use and lower mortality, a higher rate of hospitalisations before and shorter hospital stays after treatment initiation.

Highlights

Sleep apnoea (SA) is a highly prevalent condition and its prevalence is dependent mostly on age, sex and weight [1, 2]
The positive airway pressure (PAP) group had a higher rate of hospitalisation in the year before SA diagnosis than the control group (80.2% vs. 26.6%; p = 0.0016)
This real-world cohort study showed an association between long-term PAP therapy use and lower mortality, a higher rate of hospitalisations before and shorter hospital stays after treatment initiation

Summary

Introduction

Sleep apnoea (SA) is a highly prevalent condition and its prevalence is dependent mostly on age, sex and weight [1, 2]. Patients with SA have poor sleep quality and often experience excessive daytime sleepiness They are at risk of experiencing a variety of pathophysiologic health conditions, including cardiovascular disease [5,6,7], cognitive impairment, psychiatric problems, cardiovascular disease and diabetes [8, 9], and have a reduced capacity to perform activities of daily living [10, 11]. First-line treatment for SA is positive airway pressure (PAP) therapy, which prevents airway collapse during sleep. Continuous positive airway pressure (CPAP) is consistently recommended as the first-choice treatment for patients with moderate to severe OSA [12, 23], but information on long-term hard clinical outcomes is limited. Long-term hospitalisation data and total mortality rates were compared in the two patient groups

Methods

Discussion

Conclusion

Findings

Compliance with ethical guidelines