CPAP – live better, live longer.
Delivered at the European Respiratory Society International Congress in September this year, the summarised results of the landmark research included some truly significant findings, concluding that people with obstructive sleep apnea who continued their CPAP therapy were 39% more likely to survive than OSA (obstructive sleep apnea) patients who didn’t.(ref 1) Observing over 176,000 people in France with sleep apnea over a three-year period, the authors reported the survival rate gap remained significant even when accounting for patients’ ages, overall health, other pre-existing conditions, and causes of death.
The key word in this description - and one of the key comparison metrics of the entire study - is ‘continued’.
The study effectively quantified the outcomes of those OSA patients who continued their usage of their CPAP treatment (therapy adherence) compared with those who discontinued it (therapy termination).
Understandably, adherence to CPAP is primarily driven by the user’s perceived benefit, but counterintuitively, adherence decreases when there is the presence of other health problems such as diabetes, anemia or cardiovascular issues. This statistical observation has been attributed to either (or a combination of) ‘symptom misattribution’ or ‘symptom masking’. In other words, it’s believed patients can mistakenly attribute their OSA symptoms entirely to their comorbidity or the comorbidity itself reduces the OSA symptoms (such as sleepiness) due to sympathetic hyperactivity - basically an overheating of the nervous system that increases heart-rate and breathing that masks fatigue (ref 2, ref 3).
So the key takeout of the study, and the key to the ultimate better outcome – a longer life – is consistent and continued CPAP usage.
While that insight would be a reassurance and reminder to existing CPAP users, study co-author Adam Benjafield made the important point that “this finding underscores how critical it is to identify the hundreds of millions of people worldwide whose sleep apnea is undiagnosed and untreated.” An estimated 936 million people worldwide have sleep apnea(ref 4) but over 80% remain undiagnosed.(ref 5)
How to reduce these daunting statistics is occupying the best minds in public health and government (especially as the cost of untreated sleep disorders in the community is estimated to far exceed the cost of potential subsidised treatment(ref 6)). But from an individual perspective it simply starts with awareness. So, if you’re concerned that your energy levels aren’t what they should be, make an appointment with your doctor and ask about your sleep health.
And if you have already been diagnosed with OSA, the evidence is becoming increasingly clear. When it comes to CPAP treatment and your life, the statistics are mounting that it’s a case of use it or lose it.
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1 Pepin JL et al. “CPAP termination and all-cause mortality: a French nationwide database analysis.” ERS abstract, 2021
2. Wickwire E.M., Jobe S.L., Oldstone L.M., Scharf S.M., Johnson A.M., Albrecht J.S. Lower socioeconomic status and co-morbid conditions are associated with reduced continuous positive airway pressure adherence among older adult medicare beneficiaries with obstructive sleep apnea. Sleep. 2020;43 doi: 10.1093/sleep/zsaa122.
3 Pak V.M., Strouss L., Yaggi H.K., Redeker N.S., Mohsenin V., Riegel B. Mechanisms of reduced sleepiness symptoms in heart failure and obstructive sleep apnea. J. Sleep Res. 2019;28:e12778. doi: 10.1111/jsr.12778
4 Benjafield AV et al. Lancet Resp Care 2019
5 Young T et al. Sleep 1997
6 Sullivan F. In: Hidden Health Crisis Costing America Billions: Underdiagnosing and Undertreating Obstructive Sleep Apnea Draining Healthcare System. Sullivan F., editor. American Academy of Sleep Medicine; Mountain View, CA, USA: 2016
Sullivan F., editor. American Academy of Sleep Medicine; Mountain View, CA, USA: 2016