Higher ventilatory response to arousal was associated with increased odds of one-year CPAP adherence (OR 1.007; 95% CI 1.003-1.012), while higher loop gain and circulatory delay increased the hazard of stopping CPAP.
Observational (n=1,754)
No
Are OSA endotypes associated with CPAP adherence in patients with obstructive sleep apnea?
Specific OSA mechanistic traits, including ventilatory response to arousal, arousal threshold, loop gain, and circulatory delay, are associated with long-term CPAP adherence and discontinuation rates.
Effect estimate: OR 1.007 (95% CI 1.003-1.012)
Abstract Introduction High continuous positive airway pressure (CPAP) adherence is central to the effective management of obstructive sleep apnea (OSA). However, considerable variability in adherence persists that cannot be explained by known factors such as sleepiness, disease severity, or socio-economic characteristics. Preliminary analyses of endotypic traits as predictors of CPAP adherence have provided conflicting results. To overcome gaps in the literature related to the heterogeneity of data sources and designs, this study uses real-world clinical data to comprehensively analyze OSA endotypes and burdens on CPAP adherence at multiple timescales of compliance. Methods Participants consisted of patients at Brigham and Women’s Faulkner Hospital with available polysomnography and CPAP adherence data for the first 30 nights (n=1,754) and first year (n=1,527) of use. Endotypes and burdens were calculated from polysomnography recordings using PUPBeta. Adherence was defined as using the device for at least 4 hours on at least 70% of nights. Bivariate logistic regressions were performed between CPAP adherence at both time scales and each endotype/burden metric. An elastic net Cox proportional hazards analysis was performed, including all endotypes and burdens as potential predictors of night to last CPAP use and censoring at one year. Both analyses adjusted for sex, ancestry, BMI, age, and duration between PSG and CPAP dates. Results No endotypes/burdens were associated with 30-day adherence. However, each one-unit increase in ventilatory response to arousal (VRA) was associated with a 1.007-fold increased odds (95% CI=1.003-1.012) of one-year CPAP adherence. Increased hazard of stopping CPAP was associated with: (per one-standard deviation increase) lower arousal threshold (HR=0.851; 95% CI=0.752-0.971), and higher loop gain (HR=1.123; 95% CI=1.009-1.354) and circulatory delay (HR=1.088; 95% CI=1.009-1.218). Conclusion One-year but not 30-day adherence, as well as CPAP discontinuation rate, were associated with several OSA mechanistic traits. Overall, these findings underscore CPAP adherence associations with OSA mechanistic heterogeneity. The results may help inform risk assessments of patients’ likelihood of CPAP therapy adherence based on OSA endotypes and, secondarily, support strategies to improve overall adherence. Support (if any) American Academy of Sleep Medicine 338-SR-24, NIH/NHLBI R01 HL15380.
Duff et al. (2026) conducted an observational in Obstructive sleep apnea (n=1,754). OSA endotypes and burdens (e.g., ventilatory response to arousal, arousal threshold, loop gain) was evaluated on CPAP adherence (device use ≥4 hours on ≥70% of nights) at 30 days and 1 year, and time to CPAP discontinuation (OR 1.007, 95% CI 1.003-1.012). Higher ventilatory response to arousal was associated with increased odds of one-year CPAP adherence (OR 1.007; 95% CI 1.003-1.012), while higher loop gain and circulatory delay increased the hazard of stopping CPAP.