ERJ open research · 2026
The impact of positive airway pressure treatment on mortality and hospitalisation in obstructive sleep apnoea: a German database analysis.
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Woehrle Holger, Arzt Michael, Ficker Joachim H, Deger Melike, Sterling Kimberly L, Fietze Ingo, Young Peter, Vogelmann Tobias, Schoebel Christoph
Аннотация
BACKGROUND: Obstructive sleep apnoea (OSA) is a prevalent disorder. No consistent mortality benefit from treating OSA has been reported in randomised controlled trials. This analysis of an age-and-sex-representative anonymised German public health insurance database from 2015-2020 investigated mortality and hospitalisation rates in positive airway pressure (PAP)-treated versus non-PAP-treated individuals with OSA, accounting for key confounders, including demographic factors, socioeconomic status, comorbidities and medication use.
METHODS: Treatment-naïve individuals with OSA were selected and stratified by PAP prescription (PAP treated versus non-PAP-treated (controls)). All-cause mortality rates were compared between groups using Cox proportional hazard models, and all-cause hospitalisation rates were compared using 1:1 nearest neighbour matching based on estimated propensity score, age and sex. Group comparisons were made using Chi-squared tests.
RESULTS: The mortality analysis included 12 297 PAP and 10 020 non-PAP-treated individuals. During a mean 4.0 years of follow-up, 1067 people (4.8%) died; the mortality rate was significantly lower in the PAP versus non-PAP group (hazard ratio 0.87, 95% confidence interval (CI) 0.77-0.98; p=0.026). The hospitalisation analysis included 8768 PAP-treated individuals and 8768 matched controls. 1926 people (11.0%) were hospitalised; the hospitalisation rate was significantly lower in the PAP versus non-PAP group (odds ratio 0.81, 95% CI 0.74-0.89; p<0.0001).
CONCLUSION: In this comprehensive analysis, PAP therapy was associated with lower mortality and fewer hospitalisations during the follow-up period compared with no PAP therapy, though residual confounding and the observational nature of the study should be considered when interpreting the results.
METHODS: Treatment-naïve individuals with OSA were selected and stratified by PAP prescription (PAP treated versus non-PAP-treated (controls)). All-cause mortality rates were compared between groups using Cox proportional hazard models, and all-cause hospitalisation rates were compared using 1:1 nearest neighbour matching based on estimated propensity score, age and sex. Group comparisons were made using Chi-squared tests.
RESULTS: The mortality analysis included 12 297 PAP and 10 020 non-PAP-treated individuals. During a mean 4.0 years of follow-up, 1067 people (4.8%) died; the mortality rate was significantly lower in the PAP versus non-PAP group (hazard ratio 0.87, 95% confidence interval (CI) 0.77-0.98; p=0.026). The hospitalisation analysis included 8768 PAP-treated individuals and 8768 matched controls. 1926 people (11.0%) were hospitalised; the hospitalisation rate was significantly lower in the PAP versus non-PAP group (odds ratio 0.81, 95% CI 0.74-0.89; p<0.0001).
CONCLUSION: In this comprehensive analysis, PAP therapy was associated with lower mortality and fewer hospitalisations during the follow-up period compared with no PAP therapy, though residual confounding and the observational nature of the study should be considered when interpreting the results.