Real-World Observational Study of PAP Therapy Outcomes in Czech Patients With Sleep Apnea
Author(s)
Gleb Donin, PhD1, Simona Dostálová, MD, PhD2, Ondrej Gajdoš, PhD1, Jiri Vesely, MD3, Jitka Bušková, MD, PhD4, Martin Rožánek, PhD1, Aleš Tichopád, PhD1.
1Department of Biomedical Technology, Czech Technical University in Prague, Kladno, Czech Republic, 2Department of Neurology, Charles University, Prague, Czech Republic, 3Edumed, Broumov, Czech Republic, 4National Institute of Mental Health, Klecany, Czech Republic.
1Department of Biomedical Technology, Czech Technical University in Prague, Kladno, Czech Republic, 2Department of Neurology, Charles University, Prague, Czech Republic, 3Edumed, Broumov, Czech Republic, 4National Institute of Mental Health, Klecany, Czech Republic.
OBJECTIVES: To assess the association between positive airway pressure (PAP) therapy and health outcomes in adult patients with sleep apnea (SA) in the Czech Republic.
METHODS: We conducted a retrospective new-user cohort study using administrative claims data from six Czech health insurance companies, covering 44% of the insured population. Adults diagnosed with sleep apnea (ICD-10 G47.3) between 2018 and 2021 who underwent a PAP device setup procedure were included. Those initiating PAP therapy within 6 months formed the treatment group; others served as controls. Propensity score matching (1:1) was used to balance baseline characteristics, including demographics, comorbidities, and prior healthcare utilization. Primary outcomes included all-cause mortality, all-cause hospitalization, emergency unit admission, and the composite endpoints of “major adverse cardiovascular event” (MACE) and “major adverse cardiac or cerebrovascular event” (MACCE). We used Cox proportional hazards model with time-dependent exposure to address immortal time bias, adjusting for the same covariates used in the propensity score model.
RESULTS: Of 10,384 eligible patients, 8,043 (77.5%) initiated PAP therapy within 6 months. After matching, 2,341 treated and 2,341 control patients were analyzed with a median follow-up of almost 3 years. PAP therapy was associated with significantly reduced all-cause mortality (adjusted hazard ratio [aHR] = 0.69, 95% CI: 0.53-0.89, p = 0.005) and hospitalization (aHR = 0.78, 95% CI: 0.71-0.85, p < 0.001). No significant differences were observed in emergency unit admission, MACE, MACCE, or other cardiovascular events.
CONCLUSIONS: Our study confirms the real-world benefits of PAP therapy in reducing mortality and hospitalizations. Further research should explore strategies to improve adherence and evaluate long-term cardiovascular outcomes.
METHODS: We conducted a retrospective new-user cohort study using administrative claims data from six Czech health insurance companies, covering 44% of the insured population. Adults diagnosed with sleep apnea (ICD-10 G47.3) between 2018 and 2021 who underwent a PAP device setup procedure were included. Those initiating PAP therapy within 6 months formed the treatment group; others served as controls. Propensity score matching (1:1) was used to balance baseline characteristics, including demographics, comorbidities, and prior healthcare utilization. Primary outcomes included all-cause mortality, all-cause hospitalization, emergency unit admission, and the composite endpoints of “major adverse cardiovascular event” (MACE) and “major adverse cardiac or cerebrovascular event” (MACCE). We used Cox proportional hazards model with time-dependent exposure to address immortal time bias, adjusting for the same covariates used in the propensity score model.
RESULTS: Of 10,384 eligible patients, 8,043 (77.5%) initiated PAP therapy within 6 months. After matching, 2,341 treated and 2,341 control patients were analyzed with a median follow-up of almost 3 years. PAP therapy was associated with significantly reduced all-cause mortality (adjusted hazard ratio [aHR] = 0.69, 95% CI: 0.53-0.89, p = 0.005) and hospitalization (aHR = 0.78, 95% CI: 0.71-0.85, p < 0.001). No significant differences were observed in emergency unit admission, MACE, MACCE, or other cardiovascular events.
CONCLUSIONS: Our study confirms the real-world benefits of PAP therapy in reducing mortality and hospitalizations. Further research should explore strategies to improve adherence and evaluate long-term cardiovascular outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO206
Topic
Clinical Outcomes, Real World Data & Information Systems
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Neurological Disorders, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)