D97-04 CPAP Termination and Mortality in Pulmonary Fibrosis + OSA: A French Nationwide Database Analysis

Abstract Rationale Obstructive sleep apnea is a common comorbidity in people with pulmonary fibrosis, but the impact of stopping continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea on all-cause mortality in people with pulmonary fibrosis is unknown. Objectives To investigate the impact of CPAP therapy termination in the first year on all-cause mortality in people with pulmonary fibrosis and comorbid obstructive sleep apnea. Measurements and Main Results French national health insurance reimbursement system data were analyzed for all CPAP-naïve adults who started CPAP from January 2015-December 2018 and had idiopathic pulmonary fibrosis (disease codes + expert algorithm) and obstructive sleep apnea (disease codes). CPAP termination was defined as the cessation of CPAP reimbursements triggered by the physician in charge of follow-up. All-cause mortality was compared between the CPAP termination and CPAP continuation groups. Of 756,326 individuals starting CPAP, 547 had pulmonary fibrosis and obstructive sleep apnea. At 1 year, 372/547 (68%) were still using CPAP and 175/547 (32%) had terminated CPAP. Unadjusted and adjusted all-cause mortality rates were significantly higher in the CPAP termination versus continuation group. The adjusted risk of death was nearly four times higher in the CPAP termination versus continuation group (hazard ratio 3.94, 95% confidence interval 1.80-8.61). Conclusions These results highlight a substantially higher mortality risk in people with pulmonary fibrosis and obstructive sleep apnea who stop using prescribed CPAP therapy in the first year, and indicate a need to personalize strategies for these individuals, focusing on ensuring good CPAP adherence. This abstract is funded by: Resmed