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Factors influencing adherence to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure - a national registry-based cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
Lund Univ, Dept Clin Sci, Div Resp Med & Allergol, Lund, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.ORCID iD: 0000-0003-2819-2799
Lund Univ, Dept Clin Sci, Div Resp Med & Allergol, Lund, Sweden.
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2018 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 51, p. 85-91, article id S1389-9457(18)30401-5Article in journal (Refereed) Published
Abstract [en]

Objectives: Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) is crucial. Our aim was to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy.

Methods: This was a registry-based cohort study from 37 centers across Sweden with OSA patients on CPAP in the Swedevox Swedish national registry between July 2010 and March 2017.

Results: In 16,425 patients (70.8% men) with complete follow-up data after 1.2 ± 0.8 years the adjusted relative risk ratio (aRRR) for the discontinuation of CPAP was 0.57 (95% confidence interval (CI) 0.50–0.65) for use of humidifier, 0.87 (95% CI 0.82–0.92) for increasing age per 10 years, 0.80 (95% CI 0.77–0.83) for increasing apnea hypopnea index (AHI) per 5 units/hour, and 0.96 (95% CI 0.95–0.97) per increased unit on the Epworth Sleepiness Scale (ESS). Increasing BMI was associated with increased adherence up to BMI 35. Women and patients with hypertension ran an increased risk of discontinuing CPAP treatment, aRRR 1.28 (95% CI 1.12–1.46) and 1.24 (95% CI 1.12–1.42) respectively. The adjusted hazard ratio (HR) for mortality was 1.74 (95% CI 1.32–2.28) among those who did not adhere to CPAP (median follow-up period 2.4 years after the one year adherence evaluation).

Conclusion: Use of humidifier is associated with greater adherence to CPAP treatment. Other factors predicting adherence are increasing age, more severe OSA and overweight up to BMI 35, whereas female gender and coexisting hypertension are risk factors for discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Place, publisher, year, edition, pages
2018. Vol. 51, p. 85-91, article id S1389-9457(18)30401-5
Keywords [en]
Adherence, BMI, Continuous positive airway pressure (CPAP), Gender, Humidifier, Obstructive sleep apnea (OSA)
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-361337DOI: 10.1016/j.sleep.2018.07.007ISI: 000447778200013PubMedID: 30103074OAI: oai:DiVA.org:uu-361337DiVA, id: diva2:1250271
Funder
Swedish Association of Local Authorities and RegionsAvailable from: 2018-09-23 Created: 2018-09-23 Last updated: 2019-01-08Bibliographically approved
In thesis
1. Obesity, Sleep and Sleep-disordered Breathing
Open this publication in new window or tab >>Obesity, Sleep and Sleep-disordered Breathing
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sleep problems are associated with impaired quality of life and daytime sleepiness. Obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS), are associated with metabolic changes and an increased cardiovascular morbidity and mortality. The most preferred treatment of OSA and OHS is positive airway pressure (PAP) therapy. Diagnostic delay and non-adherence to PAP therapy are major clinical problems.

Aims and methods: Paper I: A longitudinal population-based cohort study aimed to investigate the role of obesity and weight gain in the development of sleep problems in 1,896 men and 5,116 women who responded to questionnaires at baseline and followed up after 10–13 years.

Paper II: A national registry-based cohort study aimed to analyse gender differences in patients with OHS starting long term mechanical ventilation (LTMV) and to study how the prescription of LTMV due to OHS has changed over time with data on 1,527 patients derived from the Swedish quality registry Swedevox between 1996 and 2014.

Paper III: A longitudinal observational cohort study aimed to investigate the impact of adherence to continuous positive airway pressure (CPAP) treatment on IGF-1 concentration in 69 patients with OSA followed up after 4.8 ± 2.5 months.

Paper IV: A national registry-based cohort study aimed to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy on 16,425 patients derived from the Swedish quality registry Swedevox between July 2010 and March 2017.

Results and conclusions: Weight gain is a risk factor for developing several sleep problems and daytime sleepiness. Women with OHS are older with a more advanced clinical picture at initiation of LTMV and start LTMV more frequently in a non-elective situation than men. CPAP usage ≥ 4 h/night is associated with increased IGF-1 concentration in patients with OSA. Use of humidifier, increasing age, more severe OSA and BMI up to 35 are associated with greater adherence to CPAP treatment. Female gender and coexisting hypertension are risk factors for the discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1496
Keywords
Sleep, Obesity, Obstructive Sleep Apnea, Obesity Hypoventilation syndrome
National Category
Respiratory Medicine and Allergy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-361345 (URN)978-91-513-0453-3 (ISBN)
Public defence
2018-11-09, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-10-17 Created: 2018-09-23 Last updated: 2018-11-19

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Palm, AndreasTheorell-Haglöw, JennyLjunggren, MirjamJanson, ChristerLindberg, Eva

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