Late Breaking Abstract - CPAP termination and all-cause mortality: a French nationwide database analysis

Pépin, Jean-Louis; Bailly, Sébastien; Lavergne, Florent; Rinder, Pierre; Adler, Dan; Benjafield, Adam; Josseran, Anne; Sinel-Boucher, Paul; Tamisier, Renaud; Cistulli, Peter A.; Malhotra, Atul; Hornus, Pierre

doi:10.1183/13993003.congress-2021.oa4390

Cited by 3 publications

(4 citation statements)

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“…In a French nationwide real-world study, patients with OSA with continued CPAP use were compared with patients that discontinued CPAP therapy. The latter had a significantly higher mortality rate which could be related to higher incident heart failure among these patients [107]. These results are in contradiction with RCTs that that suggest no reduction in cardiovascular events with the use of PAP therapy when compared with usual care [80][81][82].…”

Section: Hypertensionmentioning

confidence: 73%

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022

Gunta

Jakulla

Ubaid

et al. 2022

Cardiovascular Therapeutics

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Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.

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Section: Hypertensionmentioning

confidence: 73%

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022

Gunta

Jakulla

Ubaid

et al. 2022

Cardiovascular Therapeutics

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“…First, the total number of secondary cardiovascular events in the different RCTs was low, limiting the ability to detect between-group differences, with sufficient statistical power. A recent study by PÉPIN et al [19], based on large-scale, real-world data (88 007 patients included), showed that continuation of CPAP therapy when compared with CPAP therapy termination was associated with a significantly lower risk of all-cause death (HR (95% CI) 0.61 (0.57-0.65); p<0.01). Thus, large population-based cohort studies may be able to provide a more rounded picture of the effects of routine clinical use of CPAP on multiple outcomes, including cardiovascular morbimortality, and could represent a complement to RCTs in the future.…”

Section: Commentarymentioning

confidence: 99%

“…Although RCTs provide a high level of evidence, they may not be sufficient to capture the diversity of OSA, both in terms of clinical presentation and underlying pathophysiological mechanisms. Large-scale, real-world data may be able to provide a more rounded picture of the effects of routine clinical use of CPAP on multiple outcomes, including cardiovascular morbimortality [19]. Moreover, considering that the best treatment is the one that fulfils the needs of individual patients, precision medicine in OSA [27] may require the validation of adjuvant or alternative therapies to CPAP targeting specific endophenotypic traits [25].…”

Section: Implications For Practicementioning

confidence: 99%

CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars

Baillieul

Shah

Dharmasena

et al. 2022

Breathe

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While continuous positive airway pressure (CPAP) therapy has a strong evidence base for the treatment of obstructive sleep apnoea (OSA), its impact on cardiovascular comorbidity remains unclear. This journal club reviews three recent randomised controlled trials aimed to evaluate the impact of CPAP therapy in secondary prevention of cerebrovascular and coronary heart disease (SAVE trial), comorbid coronary heart disease (RICCADSA trial) and in patients admitted with acute coronary syndrome (ISAACC trial). All three trials included patients with moderate-to-severe OSA and excluded patients with severe daytime sleepiness. When CPAP was compared with usual care, they all reported no difference in a similar primary composite end-point including death from cardiovascular disease, cardiac events, and strokes. These trials faced the same methodological challenges, including a low primary end-point incidence, the exclusion of sleepy patients, and a low CPAP adherence. Therefore, caution must be taken when broadening their results to the wider OSA population. Although randomised controlled trials provide a high level of evidence, they may not be sufficient to capture the diversity of OSA. Large-scale, real-world data may be able to provide a more rounded and generalisable picture of the effects of routine clinical use of CPAP on cardiovascular morbimortality.

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“…17 Moreover, a recent study based on the analysis of 480,000 OSA patients in a French nationwide database who had started CPAP indicated that the overall CPAP termination rates after one, two and three years were 23, 37 and 49 percent, respectively. 18 If half of CPAP users discontinue this therapy after 3 years while the average overnight usage in the continuing CPAP users is around 3.3 hours per night, long-term mean MDA values for CPAP at 3-year follow-up are estimated to be around 20 percent. This leaves four out of five patients ineffectively treated or untreated with the "gold standard" therapy.…”

mentioning

confidence: 99%

Patient-Centric Personalized Approach in Sleep Medicine – From Theory to Practice

Vanderveken¹

2022

J Dent Sleep Med

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Late Breaking Abstract - CPAP termination and all-cause mortality: a French nationwide database analysis

Cited by 3 publications

References 0 publications

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022

CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars

Patient-Centric Personalized Approach in Sleep Medicine – From Theory to Practice

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