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Observational Study
. 2019 Jun 1;145(6):509-515.
doi: 10.1001/jamaoto.2019.0281.

Association of Positive Airway Pressure Prescription With Mortality in Patients With Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study

Quentin Lisan  1   2   3 , Thomas Van Sloten  1   2   4   5 , Pedro Marques Vidal  6 , Jose Haba Rubio  7 , Raphael Heinzer  7 , Jean Philippe Empana  1   2
Affiliations
Observational Study

Association of Positive Airway Pressure Prescription With Mortality in Patients With Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study

Quentin Lisan et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: The association of positive airway pressure (PAP) with reduced mortality in patients with obstructive sleep apnea (OSA) remains uncertain.

Objective: To investigate the association between PAP prescription and mortality.

Design, setting, and participants: This multicenter, population-based cohort study evaluated data from the Sleep Heart Health Study (SHHS), a long-term observational cohort study that included participants between 1995 and 1998, with a mean follow-up of 11.1 years. Analyses were performed in September 2018. Within the SHHS, we compared patients with obesity and severe OSA with (n = 81) and without (n = 311) prescription of PAP therapy, after matching patients from each group by age, sex, and apnea-hypopnea index.

Exposures: Self-reported use of PAP.

Main outcomes and measures: All-cause mortality.

Results: Of 392 study participants, 316 (80.6%) were men, and mean (SD) age was 63.1 (11.0) years. Ninety-six deaths occurred; 12 among the prescribed-PAP group and 84 among the nonprescribed-PAP group, yielding crude incidence rates of 12.8 vs 24.7 deaths per 1000 person-years. In Cox multivariate analysis, the hazard ratio (HR) of all-cause mortality for prescribed PAP therapy was 0.38 (95% CI, 0.18-0.81). After propensity matching, the HR of all-cause mortality for prescribed PAP therapy was 0.58 (95% CI, 0.35-0.96). According to survival curves, the difference in mortality appears 6 to 7 years after initiation of PAP therapy.

Conclusions and relevance: Positive airway pressure prescription is associated with reduced all-cause mortality, and this association appears several years after PAP initiation. If replicated, these findings may have strong clinical implications.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Van Sloten reported grants from L'institut Servier and grants from French National Research Agency during the conduct of the study. Dr Marques Vidal reported grants from the Swiss National Foundation during the conduct of the study. Dr Heinzer reported personal fees from the medical advisory board of Dreem and personal fees from the medical advisory board of NightBalance outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Curves of All-Cause Mortality for Participants With and Without Prescribed PAP
HR indicates hazard ratio; PAP, positive airway pressure.
Figure 2.
Figure 2.. Kaplan-Meier Curves of All-Cause Mortality for Participants With and Without Prescribed PAP in the Propensity-Matched Cohort
HR indicates hazard ratio; PAP, positive airway pressure.
See this image and copyright information in PMC

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References

    1. Redline S, Foody J. Sleep disturbances: time to join the top 10 potentially modifiable cardiovascular risk factors? Circulation. 2011;124(19):2049-2051. doi:10.1161/CIRCULATIONAHA.111.062190 - DOI - PubMed
    1. Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S; INCOSACT Initiative (International Collaboration of Sleep Apnea Cardiovascular Trialists) . Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation. 2017;136(19):1840-1850. doi:10.1161/CIRCULATIONAHA.117.029400 - DOI - PMC - PubMed
    1. Jonas DE, Amick HR, Feltner C, et al. . Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(4):415-433. doi:10.1001/jama.2016.19635 - DOI - PubMed
    1. Heinzer R, Vat S, Marques-Vidal P, et al. . Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318. doi:10.1016/S2213-2600(15)00043-0 - DOI - PMC - PubMed
    1. Haba-Rubio J, Marti-Soler H, Tobback N, et al. . Sleep characteristics and cognitive impairment in the general population: the HypnoLaus study. Neurology. 2017;88(5):463-469. doi:10.1212/WNL.0000000000003557 - DOI - PubMed

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