Can patient use of continuous positive airway pressure (CPAP) treatment be improved?
Obstructive sleep apnea (OSA) is a highly common ongoing respiratory condition that may lead to poor health outcomes, including decreased mental function, high blood pressure, heart disease and early death. CPAP is continuous positive airway pressure, a type of breathing support used to treat OSA.
The research showed that age, gender and having more than one health condition influenced whether patients were more likely to stop or continue CPAP therapy, suggesting personalised care is important .
The anonymised data of more than 480,000 French new CPAP users aged 18 years or older was analysed from the French National Health insurance reimbursement system databases service SNDS (‘Système national des données de santé’)
Read on to learn how sharing health data can save lives
Why was this work needed?
Obstructive sleep apnea (OSA) is a highly common, ongoing respiratory condition and happens when the muscles in the back of the throat relax too much to allow normal breathing whilst asleep. This condition is commonly treated with continuous positive airway pressure therapy (CPAP), a type of breathing support worn by patients with OSA when sleeping. It is a simple idea with three basic parts. The first is an air pump (CPAP machine), the second is a mask that covers the nose and sometimes the mouth and the third is a tube that links the two. CPAP works by providing a positive pressure of air through the mask and into the airway, which holds the airway open while sleeping. This helps to prevent breathing difficulties.
Global estimates suggest that almost 1 billion people aged 30–69 years have OSA. Of these, 425 million have moderate to severe disease .
OSA can contribute to several poor health outcomes, including reduced mental function, high blood pressure, heart disease and early death. Diagnosis and treatment of OSA can be costly. However, it is hugely important to recognise and to treat OSA to reduce work sick days, accidents at work  or whilst driving  and an increase in the symptoms of other existing medical illnesses.
This research conducted in France looked at which personal characteristics and other illnesses increased the risk of patients stopping their CPAP treatment.
What did this research find?
This research showed that a patient’s age, their gender and having more than one other health condition at the same time as OSA affected whether they were more likely to stop or continue CPAP treatment. These conditions included:
- High blood pressure also known as hypertension when there is high pressure in the arteries (vessels that carry blood from the heart to the rest of the body).
- Diabetes – a lifelong condition that causes a person’s blood sugar level to become too high. (There are 2 main types of diabetes: type 1 diabetes – where the body’s immune system attacks and destroys the cells that produce insulin; type 2 diabetes – where the body does not produce enough insulin, or the body’s cells do not react to insulin).
- Chronic obstructive pulmonary disease (COPD) – the name for a group of lung conditions that make it hard to breathe such as:
- Emphysema -damage to the air sacs in the lungs
- Chronic bronchitis – long-term inflammation of the airways
People with obstructive sleep apnea who continued use of CPAP were 39% more likely to survive than OSA patients who did not. 
In the above diagram the red traffic light shows patients who are more likely to stop their CPAP treatment and the green light those who are more likely to continue their CPAP treatment.
What was the impact on patients?
The main symptom of OSA is daytime sleepiness. Patients who have other underlying health conditions may not see OSA as their main priority leading to a belief that their other conditions may have a greater impact on their wellbeing and life expectancy. This may be one of the reasons that patients with other health conditions stop their CPAP treatment.
Individualised care and providing care that the patient finds acceptable is important in order to encourage patients to continue with their CPAP treatment.
What data was used?
The anonymised data of French new CPAP users aged 18 years or older were analysed from the French National Health insurance reimbursement system databases service SNDS (‘Système national des données de santé’) between January 2015 and December 2016.
Who funded and collaborated on this work?
The ALASKA project is a collaboration between industry and academia conducted in partnership with Professor Jean-Louis Pépin, (‘e-health and integrated care and trajectories medicine and MIAI artificial intelligence’ Chairs of excellence; universities of Grenoble) Sêmeia (French Start-up specialized in big data analysis using artificial intelligence and ResMed. Analysis is based on data from the Système National des Données de Santé (SNDS) national health data system.
The project was approved by the ‘Commission Nationale Informatique et Liberté’ (CNIL), the French information technology, and personal data protection authority (DR-2019-78 and n°919194).
 Pépin J-L, Bailly S, Rinder P, Adler D, Szeftel D, Malhotra A, Cistulli PA, Benjafield A, Lavergne F, Josseran A, Tamisier R, Hornus P, on behalf of the medXcloud Group. CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis. Journal of Clinical Medicine. 2021; 10(5):936.
Article available from https://doi.org/10.3390/jcm10050936
 Benjafield AV et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respiratory Medicine 2019; 7(8):687-698.
Article available from https://doi.org/10.1016/S2213-2600(19)30198-5
 Sanna A. Obstructive sleep apnoea, motor vehicle accidents, and work performance. Chronic Respiratory Disease. February 2013:29-33.
Article available from https://doi.org/10.1177/1479972312473134
 Mark W. Purtle, Catherine Hackett Renner, Dustin A. McCann, James C. Mallen, Sarah K. Spilman & Sheryl M. Sahr (2020) Driving with undiagnosed obstructive sleep apnea (OSA): High prevalence of OSA risk in drivers who experienced a motor vehicle crash, Traffic Injury Prevention, 21:1, 38-41.
Article available from https://doi.org/10.1080/15389588.2019.1709175
 Pepin JL et al. “CPAP termination and all-cause mortality: a French nationwide database analysis.” ERS abstract, 2021
This work uses data provided by patients and collected by the health professionals as part of the care and support provided.