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JAMA Otolaryngol Head Neck Surg. 2019 Apr 11. doi: 10.1001/jamaoto.2019.0281. [Epub ahead of print]

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

Author information

1
Paris Descartes University, Faculty of Medicine, Paris, France.
2
INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.
3
Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France.
4
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
5
Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
6
Department of medicine, Service of internal medicine, Lausanne University Hospital, Lausanne, Switzerland.
7
Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.

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 (nā€‰=ā€‰81) and without (nā€‰=ā€‰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.

PMID:
30973594
DOI:
10.1001/jamaoto.2019.0281

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