Introduction: The healthy adherer effect (HAE) is particularly relevant to compare health outcomes of patients with obstructive sleep apnea (OSA) according to their adherence to positive airway pressure (PAP) therapy. We aimed to assess whether PAP adherence is associated with proxies of HAE prior to device prescription.

Methods: Data from the Pays de la Loire Sleep Cohort were linked to health administrative data to identify surrogates of HAE including smoking habits, cancer screening tests, flu vaccination, adherence to cardiovascular (CV) drugs assessed by the medication possession ratio (MPR) and drowsiness-related road accident during the 2 years preceding PAP onset, in OSA patients. Multivariable regression analyses were conducted to evaluate the association of PAP adherence with proxies of HAE.

Results: 3,092 patients who had been prescribed PAP between 2012 and 2018 were analyzed (median age[IQR] 62[13] years, 68% male). At 2 years, 66% of the patients were PAP adherent (mean daily use ?4h). Among patients receiving at least 1 CV drug (n=1,744), those with MPR ?80% were twice as likely to then adhere to PAP (adjusted OR[CI95%] 2.03[1.29-3.18]). Current smokers and patients who reported drowsiness-related near missed or car accidents were less likely to be PAP adherent (adjusted OR 0.66[0.47-0.91] and 0.78[0.62-0.99] respectively). There was no association of adherence to cancer screening tests and flu vaccination with future PAP adherence.

Conclusion: Smoking habits, CV drug adherence and drowsiness-related car accident are associated with subsequent PAP adherence in OSA. Proxies of HAE should be taken into account when examining the association of PAP adherence with health outcomes.