From CPAP Prescription to Long-Term Follow-Up: Care Pathway, Adherence, and Multidomain Treatment Outcomes in Obstructive Sleep Apnea

Background/Objectives: Long-term continuous positive airway pressure (CPAP) management involves both engagement with care and sustained treatment outcomes. We aimed to characterize long-term follow-up attendance, longitudinal adherence, and multidomain treatment outcomes in patients with obstructive sleep apnea (OSA). Methods: We studied 172 adults with OSA who entered a real-world CPAP care pathway. Long-term attendance was evaluated among patients with ≥30 months of potential follow-up from CPAP prescription, with 24- and 36-month thresholds examined in sensitivity analyses. Longitudinal adherence and multidomain outcomes were assessed among patients with available follow-up data. Results: Among 114 patients in the primary long-term follow-up risk set, 80 (70.2%) attended; attendance was similar using 24- and 36-month thresholds (68.5% and 72.8%). Older age was associated with greater attendance (odds ratio 1.58 per 10-year increase, 95% confidence interval 1.10–2.28). Among 94 patients with paired adherence data, adherence according to available device-recorded nights was 78.7% at first and 79.8% at long-term follow-up, although 11.7% changed adherence category. At long-term assessment, device-recorded CPAP adherence, device-derived respiratory control (predefined residual apnea-hypopnea index [AHI] < 5 events/hour criterion), absence of residual sleepiness, and perceived treatment benefit were observed in 79.8%, 47.8%, 87.8%, and 89.3% of patients with available data, respectively. Among 71 patients with complete multidomain data, 45.1% simultaneously met all four predefined treatment-domain criteria, increasing to 63.4% using residual AHI < 10 events/hour. Conclusions: Care-pathway attendance and treatment outcomes represent distinct dimensions of long-term CPAP management. Similar aggregate adherence according to available device-recorded nights across assessments may conceal individual differences in adherence classification between observation intervals, while treatment outcomes are only partially concordant. Multidimensional reassessment may therefore identify clinically relevant discordance beyond adherence alone.