Association of CPAP Prescription and Pneumonia Among Patients with Obstructive Sleep Apnea in the United States: A Retrospective Database Analysis

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Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea (OSA). We sought to understand whether CPAP prescription among adults diagnosed with OSA was associated with a higher likelihood of pneumonia diagnosis and inpatient hospitalization for pneumonia after adjusting for patient demographic characteristics and comorbidities. This retrospective cohort study used de-identified data from the Optum Clinical Electronic Health Record (EHR) database for the time period January 2012 to December 2019. The study population comprised adults with an OSA diagnosis with and without CPAP prescription after the initial diagnosis. The primary outcome of interest was a pneumonia diagnosis in the first year following OSA diagnosis. Propensity score matching was used to balance the cohorts. Logistic regression was used to estimate the odds of developing pneumonia. There were 328,340 patients with an OSA diagnosis and evidence of CPAP prescription and 964,199 patients with an OSA diagnosis without evidence of CPAP prescription. After 1:1 propensity score matching, 326,145 were included in each cohort. The risk of pneumonia in any setting and in the inpatient setting was higher among patients with CPAP prescription, odds ratio (OR), 1.06 (95% CI: 1.03, 1.09) and 1.24 (95% CI, 1.20, 1.29), respectively. The odds of developing pneumonia increased in any setting when CPAP was initiated on the date of OSA diagnosis (OR = 1.68, 95% CI: 1.62–1.72) among all patients, for patients aged 65 + years (OR = 1.68, 95% CI: 1.47, 1.92), patients with obesity (OR = 1.59, 95% CI: 1.47, 1.72), and patients with a history of pneumonia (OR = 1.68, 95% CI: 1.41, 2.00). This study indicates that among patients with OSA, CPAP initiation was associated with incident pneumonia, particularly inpatient pneumonia hospitalizations. Longer CPAP prescription, older age, obesity, and previous history of pneumonia further increased the risk of incident pneumonia associated with CPAP prescription. Obstructive sleep apnea (OSA) is a common condition where people stop breathing for short periods of time during sleep. It is often treated with a continuous positive airway pressure (CPAP) machine, which helps keep the airway open. It is not clear whether using a CPAP machine increases the risk of getting pneumonia. Therefore, this study analyzed the health records of over 1.3 million adults with diagnosis of obstructive sleep apnea from 2012 to 2019 to assess whether prescriptions for a CPAP machine were linked to increased risk of pneumonia. The analysis found that adults with a CPAP prescription had an 18% higher risk of getting pneumonia and a 32% higher risk of being hospitalized for pneumonia compared to those not having a prescription for a CPAP machine. Pneumonia risk was highest when CPAP machine was prescribed on the same day as the OSA diagnosis, especially for patients that were hospitalized. Delayed CPAP prescription, on the other hand, was associated with reduced risk for pneumonia. Older adults, people with obesity or low body weight, and those with a history of prior pneumonia had an amplified association between CPAP prescription and pneumonia risk. The study however was not able to account for the patients’ degree of severity of their obstructive sleep apnea, the type of CPAP machines, or how well patients used and cared for their CPAP machines.

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