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Published on: December 6, 2016
Mask-Type Switching Trajectories and CPAP Use in Long-Term Obstructive Sleep Apnoea: The SwitchAdene Real-World
Celia Vidal1, Jean-Pierre Mallet2, Raphaël Gilson3
1IDESP, INSERM, PreMEdical INRIA, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France; Groupe Adène, Montpellier, France.
Objective:
To characterise long-term mask-type trajectories among patients receiving continuous positive airway pressure (CPAP) and assess their associations with CPAP nonadherence and treatment termination.
Methods:
This real-world longitudinal cohort study included newly diagnosed adults treated with CPAP for more than 1 month. Patients had unrestricted access to 48 models across 4 mask types: nasal masks (NMs), oronasal masks (ONMs), and nasal-pillow masks (NPMs), with the latter subdivided into nasal-cradle masks (NCMs) and intranasal masks (INMs). Sequence analysis was used to identify mask trajectories, and multivariable models were used to estimate odds ratios (ORs) for CPAP nonadherence and treatment termination.
Results:
Among 4675 patients, the median duration of CPAP treatment was 1.5 years (IQR, 0.7-2.8 years); 21.8% were nonadherent, and 26.1% terminated treatment. Adherent patients changed mask type less frequently than nonadherent patients and those who terminated treatment (43.7% vs 50.4% and 53.8%, respectively; p<.001). NM use decreased from 72.3% to 43.1%, whereas ONM use increased from 19.8% to 37.0%, INM use from 2.4% to 6.5%, and NCM use from 5.5% to 13.4%. Fifteen trajectories were identified. Compared with NM renewal, ONM and INM renewal were not associated with a higher risk of nonadherence or treatment termination, whereas NCM renewal was associated with CPAP termination (OR, 1.60; 95%CI, 1.04-2.47; p=.034). Switching from an initial NM to an INM (OR, 1.68; 95%CI, 1.18-2.39; p=.004), NCM (OR, 1.76; 95%CI, 1.26-2.45; p=.001), or ONM (OR, 1.31; 95%CI, 1.01-1.70; p=.046) was associated with CPAP termination.
Conclusions:
In routine clinical practice, NM, ONM, and INM renewal trajectories were comparable, whereas NCM renewal was associated with unfavourable outcomes. Switching from an NM to an ONM or NPM was associated with poorer CPAP use. NCMs and INMs should not be pooled under the general NPM category.
Trial Registration:
The SwitchAdene study is registered with the Health Data Hub under registration No. 19334378.