The Impact of PAP Treatment on Mortality and Hospitalization in OSA: A German Database Analysis

Background Obstructive sleep apnea (OSA) is a prevalent disorder. No consistent mortality benefit from treating OSA has been reported in randomized controlled trials. This analysis of an age-and-sex -representative anonymized German public health insurance database from 2015–2020 investigated mortality and hospitalization rates in positive airway pressure (PAP)-treated versus non-PAP-treated individuals with OSA, accounting for key confounders, including demographic factors, socioeconomic status, comorbidities, and medication use. Methods Treatment naïve individuals with OSA were selected and stratified by PAP prescription (PAP treated versus non-PAP-treated [controls]). All-cause mortality rates were compared between groups using Cox proportional hazard models, and all-cause hospitalization rates were compared using 1:1 nearest neighbor matching based on estimated propensity score, age, and sex. Group comparisons were made using Chi-squared tests. Results The mortality analysis included 12 297 PAP and 10 020 non-PAP-treated individuals. During a mean 4.0 years of follow-up, 1067 people (4.8%) died; the mortality rate was significantly lower in the PAP versus non-PAP group (hazard ratio 0.87, 95% confidence interval [CI] 0.77–0.98; p=0.026). The hospitalization analysis included 8768 PAP-treated individuals and 8768 matched controls. 1926 people (11.0%) were hospitalized; the hospitalization rate was significantly lower in the PAP versus non-PAP group (odds ratio 0.81, 95% CI 0.74–0.89; p<0.0001). Conclusion In this comprehensive analysis, PAP therapy was associated with lower mortality and fewer hospitalizations during the follow-up period compared with no PAP therapy,, though residual confounding and the observational nature of the study should be considered when interpreting the results.