Whether PAP therapy discontinuation is associated with adverse health outcomes in patients with OSA is a major issue that needs to be assessed with proper confounding adjustment.

This study aimed to determine whether PAP therapy discontinuation is associated with an increased incidence of major adverse cardiovascular events (MACEs, composite outcome of mortality, stroke, and cardiac diseases) compared with PAP continuation with ?4h/night use.

Data from the Pays de la Loire Sleep Cohort were linked to the French national health insurance database to identify incident MACEs and CV active drug (lipid-lowering drugs, antiplatelet agent, beta-blockers, and antihypertensive drugs) adherence assessed by the Medication Possession Ratio (MPR). The independent association of PAP discontinuation (vs continuation) with MACEs risk was evaluated using a time-dependent survival Cox model, with adjustment for major CV risk factors and CV drug status.

After a median follow-up of 8 [6; 11] years, 1,130 (24%) of 4,775 patients experienced MACEs. In addition, 1679 (35%) had discontinued PAP treatment while 3,096 remained PAP adherent. PAP discontinuation was associated with a significant decrease in CV active drug MPR (p=0.006), particularly for lipid-lowering and antihypertensive drugs. After adjustment for major confounders including CV drug status, PAP discontinuation was associated with a 30% increased risk of MACEs (HR: 1.30 95%CI: [1.12-1.47]) compared to adherent PAP continuation.

In real-life conditions, PAP treatment discontinuation was associated with an increased risk of MACEs after adjustment for confounders including adherence to CV active drugs.