Predictors of positive airway pressure therapy termination in the first year: analysis of big data from a German homecare provider

Woehrle, Holger; Arzt, Michael; Graml, Andrea; Fietze, Ingo; Young, Peter; Teschler, Helmut; Ficker, Joachim H.

doi:10.1186/s12890-018-0748-8

Cited by 20 publications

(21 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings of higher rates of therapy termination in females versus males, and in the youngest and oldest patient groups, are consistent with a big data analysis from Germany [ 15 ]. However, despite increasing recognition of OSA as an important contributor to chronic diseases [ 16 ], there has been little analysis to date regarding the effects of comorbidities on CPAP usage and therapy termination.…”

Section: Discussionsupporting

confidence: 91%

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

Pépin¹,

Bailly²,

Rinder³

et al. 2021

JCM

View full text Add to dashboard Cite

The nationwide claims data lake for sleep apnoea (ALASKA)—real-life data for understanding and increasing obstructive sleep apnea (OSA) quality of care study—investigated long-term continuous positive airway pressure (CPAP) termination rates, focusing on the contribution of comorbidities. The French national health insurance reimbursement system data for new CPAP users aged ≥18 years were analyzed. Innovative algorithms were used to determine the presence of specific comorbidities (hypertension, diabetes and chronic obstructive pulmonary disease (COPD)). Therapy termination was defined as cessation of CPAP reimbursements. A total of 480,000 patients were included (mean age 59.3 ± 13.6 years, 65.4% male). An amount of 50.7, 24.4 and 4.3% of patients, respectively, had hypertension, diabetes and COPD. Overall CPAP termination rates after 1, 2 and 3 years were 23.1, 37.1 and 47.7%, respectively. On multivariable analysis, age categories, female sex (1.09 (1.08–1.10) and COPD (1.12 (1.10–1.13)) and diabetes (1.18 (1.16–1.19)) were significantly associated with higher CPAP termination risk; patients with hypertension were more likely to continue using CPAP (hazard ratio 0.96 (95% confidence interval 0.95–0.97)). Therapy termination rates were highest in younger or older patients with ≥1 comorbidity. Comorbidities have an important influence on long-term CPAP continuation in patients with OSA.

show abstract

Section: Discussionsupporting

confidence: 91%

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

Pépin¹,

Bailly²,

Rinder³

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…На сегодняшний день СРАР-терапия признается единственно обоснованной патогенетической терапией данного заболевания [10]. Однако разнообразные режимы СРАР и необходимая длительность ночных сеансов остаётся малоизученной, особенно в случае коморбидных пациентов ОАС+РАГ [18]. Несмотря на простой дизайн, отсутствие «ослепления», плацебо контроля и рандомизации пациентов, нам удалось достичь минимального воздействия на конечный результат путём формирования исследуемой группы и применения анализа в соответствии с исходно назначенным лечением («intention-to-treat analyses» -ITT) [16].…”

Section: Discussionunclassified

“…Несмотря на простой дизайн, отсутствие «ослепления», плацебо контроля и рандомизации пациентов, нам удалось достичь минимального воздействия на конечный результат путём формирования исследуемой группы и применения анализа в соответствии с исходно назначенным лечением («intention-to-treat analyses» -ITT) [16]. Наши данные полностью согласуются с рядом исследований влияния СРАР-терапии на нормализацию эндотелиальной функции, сосудистой жёсткости и артериального давления у пациентов ОАС [18,19]. Однако, нами впервые установлена особенность назначения ночных сеансов A-Flex у тяжёлых пациентов ОАС+РАГ, когда её длительность >6 час/ночь позволяет достигать целевых значений САД/ДАД, RHI и AI на 6-ой месяц терапии.…”

Section: Discussionunclassified

Blood Pressure and Arterial Stiffness Dynamics Depending on the Duration of Cpap Night Sessions in Patients With Severe Obstructive Sleep Apnea

Горбунова¹,

Бабак²,

Адашева³

et al. 2019

Arhivʺ vnutrennej mediciny

View full text Add to dashboard Cite

Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index >30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex > 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode > 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications.

show abstract

“…Descriptive statistics were used to present the demographic and therapy characteristics for the primary analysis population, including age, sex, myAir TM use, and device mode. Descriptive statistics were also used to present the mean usage, the proportion of patients with mean usage of ≥4 h/night, the proportion of patients with a usage of ≥4 h/night on 70% of nights, the mean AHI, the median 95th percentile mask leak between 91 and 360 days after initiation of therapy, and the proportion of patients who terminated therapy (i.e., PAP therapy termination, as studied previously) [ 18 , 19 , 20 ]. Continuous parameters were compared between groups using a mixed-effect linear model, with the pair identifier as a random effect and the resupply/control group as a fixed effect.…”

Section: Methodsmentioning

confidence: 99%

Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis

Benjafield

Oldstone

Willes³

et al. 2021

JCM

View full text Add to dashboard Cite

There are currently few data on the impact of mask resupply on longer-term adherence to positive airway pressure (PAP) therapy. This retrospective analysis investigated the effects of mask/mask cushion resupply on the adherence to PAP versus no resupply. Deidentified patient billing data for PAP supply items were merged with telemonitoring data from Cloud-connected AirSense 10/AirCurve 10 devices via AirViewTM (ResMed). Eligible patients started PAP between 1 July 2014 and 17 June 2016, had ≥360 days of PAP device data, and achieved initial U.S. Medicare adherence criteria. Patients who received a resupply of mask systems/cushions (resupply group) were propensity-score-matched with those not receiving any mask/cushion resupply (control group). A total of 100,370 patients were included. From days 91 to 360, the mean device usage was 5.6 and 4.5 h/night in the resupply and control groups, respectively (p < 0.0001). The proportion of patients with a mean device usage ≥4 h/night was significantly higher in the resupply group versus the control group (77% vs. 59%; p < 0.0001). The therapy termination rate was significantly lower in the resupply group versus the control group (14.7% vs. 31.9%; p < 0.0001); there was a trend toward lower therapy termination rates as the number of resupplies increased. The replacement of mask interface components was associated with better longer-term adherence to PAP therapy versus no resupply.

show abstract

Predictors of positive airway pressure therapy termination in the first year: analysis of big data from a German homecare provider

Cited by 20 publications

References 38 publications

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

Blood Pressure and Arterial Stiffness Dynamics Depending on the Duration of Cpap Night Sessions in Patients With Severe Obstructive Sleep Apnea

Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis

Contact Info

Product

Resources

About