Relationship Between CPAP Termination and All-Cause Mortality

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

doi:10.1016/j.chest.2022.02.013

Cited by 68 publications

(38 citation statements)

References 37 publications

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“…After removing 112 participants with positive airway pressure use at baseline, there was an association between COMISA and mortality in the unadjusted model, but not after adjusting for co-variates. As OSA treatment may be protective against mortality risk, 55 this is somewhat surprising. Attenuation of the relationship between COMISA and mortality may have been due to the reduction in sample size, or more complex relationships between rates of positive airway pressure therapy acceptance, use and rejection/survival between people with OSA alone and COMISA.…”

Section: Discussionmentioning

confidence: 99%

All-Cause Mortality in People with Co-Occurring Insomnia Symptoms and Sleep Apnea: Analysis of the Wisconsin Sleep Cohort

Lechat¹,

Loffler²,

Wallace³

et al. 2022

NSS

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Purpose Insomnia symptoms and sleep apnea frequently co-occur and are associated with worse sleep, daytime function, mental health and quality of life, compared to either insomnia or obstructive sleep apnea (OSA) alone. This study aimed to investigate the association of symptoms of co-morbid insomnia and sleep apnea (COMISA) with all-cause mortality. Patients and Methods Wisconsin Sleep Cohort data were analysed to assess potential associations between COMISA symptoms and all-cause mortality. Nocturnal insomnia symptoms were defined as difficulties initiating sleep, maintaining sleep, and/or early morning awakenings “often” or “almost always”, and/or regular sedative-hypnotic medicine use. OSA was defined as an apnea-hypopnea index ≥5/hr sleep. Participants were classified as having neither insomnia symptoms nor OSA, insomnia symptoms alone, OSA alone, or COMISA symptoms. Associations between the four groups and all-cause mortality over 20 years of follow-up were examined via multivariable adjusted Cox regression models. Results Among 1115 adult participants (mean ± SD age 55 ± 8 years, 53% males), 19.1% had COMISA symptoms. After controlling for sociodemographic and behavioral factors, COMISA symptoms were associated with an increased risk of all-cause mortality compared to no insomnia symptoms or OSA (HR [95% CI]; 1.71 [1.00–2.93]). OSA alone (0.91 [0.53, 1.57]) and insomnia symptoms alone (1.04 [0.55, 1.97]) were not associated with increased mortality risk. Conclusion Co-morbid insomnia symptoms and sleep apnea is associated with increased all-cause mortality risk. Future research should investigate mechanisms underpinning COMISA and the effectiveness of different treatment approaches to reduce mortality risk for this common condition.

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Section: Discussionmentioning

confidence: 99%

All-Cause Mortality in People with Co-Occurring Insomnia Symptoms and Sleep Apnea: Analysis of the Wisconsin Sleep Cohort

Lechat¹,

Loffler²,

Wallace³

et al. 2022

NSS

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“…However, we could not exclude the risk of the statistical model overcontrolling, misclassification bias and unmeasured confounding (for example, information on body mass index was not available) impacting our results. Another explanation is confounding by PAP treatment, as the risk of death from respiratory suppression is lowered by PAP therapy [ 74 ]. However, at the same time, we cannot exclude a healthy user effect, i.e., those who are in better health claimed PAP and live longer, or a survival bias as some individuals may not live long enough to get PAP therapy.…”

Section: Discussionmentioning

confidence: 99%

Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data

et al. 2022

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Rationale Despite the high prevalence of obstructive sleep apnea (OSA) and concurrent use of opioid therapy, no large-scale population studies have investigated whether opioid use and pre-existing OSA may interact synergistically to increase the risk of adverse health consequences. To address this knowledge gap, we conducted a retrospective cohort study using provincial health administrative data to evaluate whether the combined presence of opioid use and OSA increases the risk of adverse health consequences, such as mortality, hospitalizations, and emergency department (ED) visits; and if it does, whether this co-occurrence has synergistic clinical relevance. Methods We included all adults who underwent a diagnostic sleep study in Ontario, Canada, between 2013 and 2016. Individuals were considered exposed to opioids if they filled a prescription that overlapped with the date of their sleep study (Opioid+). Individuals with at least a 50% probability of having a diagnosis of moderate to severe OSA (OSA+) were identified using a previously externally validated case-ascertainment model. The primary outcome was all-cause mortality; secondary outcomes were all-cause or ischemic heart disease hospitalizations, all-cause ED visits, and motor vehicle collisions (MVC) requiring hospital or ED visit. We used multivariable Cox regression models to compare hazards between four mutually exclusive groups: (1) Opioid+ OSA+; (2) Opioid+ OSA-; (3) Opioid- OSA+, and (4) OSA- Opioid- (reference for comparison). Relative excess risks due to interaction (RERI) were calculated to test for additive interaction. Results Of 300,663 adults who underwent a sleep study, 15,713 (5.2%) were considered as Opioid+ and 128,351 (42.7%) as OSA+. Over a median of two years, 6,223 (2.1%) died from any cause. Regardless of OSA status, opioid use at the date of the sleep study was associated with an increased hazard for all-cause mortality with the greatest hazard associated with Opioid+ OSA- (adjusted hazard ratio [aHR]: 1.75, 95% CI 1.57–1.94), but not Opioid+ OSA+ (aHR: 1.14, 95% CI 1.02–1.27) as hypothesized. Regardless of OSA status, opioid use at the date of the sleep study was associated with an increased hazard for all secondary outcomes. Opioid+ OSA+ was associated with the greatest hazards of all-cause hospitalizations (aHR 1.55, 95% CI 1.49–1.61) and MVC (aHR of 1.39; 95% CI 1.09–1.77); however, no statistically significant synergistic effects were observed. Conclusions Adults referred for sleep disorder assessment who used opioids had a significantly increased hazard of adverse health outcomes than those who did not, regardless of whether they had a high probability of moderate to severe OSA. The use of opioids and OSA was associated with the greatest hazard of all-cause hospitalizations and MVC requiring hospital or ED visit. The interaction of opioids and OSA did not confer a synergistic risk for poor outcomes.

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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 – 82 ].…”

Section: Effect Of Osa Therapy On the CV Morbidity And Mortalitymentioning

confidence: 99%

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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Relationship Between CPAP Termination and All-Cause Mortality

Cited by 68 publications

References 37 publications

All-Cause Mortality in People with Co-Occurring Insomnia Symptoms and Sleep Apnea: Analysis of the Wisconsin Sleep Cohort

All-Cause Mortality in People with Co-Occurring Insomnia Symptoms and Sleep Apnea: Analysis of the Wisconsin Sleep Cohort

Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data

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

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