University Grenoble Alpes and HP2 Laboratory, INSERM, Grenoble, France.
University of California San Diego, San Diego, California.
Ann Am Thorac Soc. 2024 Nov;21(11):1592-1599. doi: 10.1513/AnnalsATS.202404-389OC.
Three-year continuous positive airway pressure (CPAP) therapy termination rates are up to 50%, and therapy termination is associated with higher all-cause mortality and incident cardiovascular event risk. This study investigated the impact of CPAP therapy termination in the first year on long sick leave leading to permanent work disability in patients with obstructive sleep apnea based on data from the Nationwide Claims Data Lake for Sleep Apnoea (ALASKA). French national health insurance reimbursement system data were analyzed for all adults with OSA aged ≤62 years who started CPAP therapy in France in 2015 and 2016. CPAP therapy termination was defined as the cessation of CPAP reimbursements triggered by the respiratory physician or sleep specialist in charge of follow-up. Individuals who terminated therapy were compared with those who continued to use CPAP. The primary outcome was sick leave ultimately leading to permanent work disability. A multivariable Fine and Gray model, adjusted for age, sex, cardiovascular and metabolic comorbidities, depression, and CPAP prescriber clinical specialty was used to assess the risk of long-term sick leave leading to permanent work disability over 3 years' follow-up. The analysis included 174,270 individuals (median age, 52.0 yr [interquartile range, 44.0-57.0 yr]; 67.5% male). The 1-year CPAP therapy termination rate was 22.3%. The proportion of individuals with long-term sick leave leading to permanent work disability was significantly higher in the CPAP termination versus continuation group (0.60% vs. 0.52%; = 0.042). In an adjusted multivariable Cox model, CPAP termination was associated with an increased risk of permanent work disability (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41; = 0.01), primarily in the subgroup aged >55 years (hazard ratio, 1.41; 95% CI, 1.06-1.87; = 0.02). These real-world data from a comprehensive, unbiased database highlight the potential occupational impact of CPAP therapy termination.
持续气道正压通气（CPAP）治疗的三年终止率高达 50%，而治疗终止与全因死亡率和心血管事件风险增加相关。这项研究基于睡眠呼吸暂停全国索赔数据湖（ALASKA）的数据，调查了阻塞性睡眠呼吸暂停患者在第一年 CPAP 治疗终止对长期病假导致永久性工作残疾的影响。分析了法国国家健康保险报销系统的数据，该数据涵盖了 2015 年和 2016 年在法国开始 CPAP 治疗且年龄≤62 岁的所有阻塞性睡眠呼吸暂停成年人。CPAP 治疗终止被定义为负责随访的呼吸内科医生或睡眠专家停止 CPAP 报销。将终止治疗的个体与继续使用 CPAP 的个体进行比较。主要结局是最终导致永久性工作残疾的病假。使用多变量 Fine 和 Gray 模型，根据年龄、性别、心血管和代谢合并症、抑郁和 CPAP 处方临床专业调整，评估了 3 年随访期间长期病假导致永久性工作残疾的风险。分析包括 174270 人（中位年龄 52.0 岁[四分位距 44.0-57.0 岁]；67.5%为男性）。1 年 CPAP 治疗终止率为 22.3%。在 CPAP 终止组与继续组中，长期病假导致永久性工作残疾的比例明显更高（0.60% vs. 0.52%；=0.042）。在调整后的多变量 Cox 模型中，CPAP 终止与永久性工作残疾的风险增加相关（风险比 1.21；95%置信区间[CI] 1.04-1.41；=0.01），主要在年龄>55 岁的亚组中（风险比 1.41；95%CI 1.06-1.87；=0.02）。这些来自全面、无偏倚数据库的真实世界数据突出了 CPAP 治疗终止对职业的潜在影响。
