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We identified patients newly starting CPAP therapy as their first-line SAS treatment, and assessed patient characteristics, CPAP persistence rates, predictors of CPAP discontinuation, and second-line therapy options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analysis population (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913,007) was 76.2% male, and the mean age (\u00b1\u2009standard deviation) was 64.0\u2009\u00b1\u200915.0 years. CPAP persistence rates were 90.1% at 90 days, 77.1% at one year, 70.3% at two years, and 66.5% at three years. More discontinuation was noted in patients aged 18 to 44 (adjusted hazard ratio [95% confidence interval]: 1.27 [1.13\u20131.42]) and \u2265\u200965 (65\u201374 years, 1.18 [1.07\u20131.30]; \u226575 years, 1.59 [1.43\u20131.76]) than in those aged 45 to 64. Comorbidities of dementia (1.47 [1.25\u20131.73]), insomnia (1.26 [1.16\u20131.36]), and restless legs syndrome (RLS, 1.60 [1.16\u20132.23]) were also associated with more discontinuation. Testing with a Type 3 portable monitor (1.31 [1.21\u20131.42]), or no record of sleep testing before therapy (1.21 [1.09\u20131.36]), tended to be associated with more discontinuation than polysomnography. CPAP therapy starting in 2020 (0.72 [0.63\u20130.82]) and 2021 (0.63 [0.46\u20130.85]) resulted in better persistence than that starting in 2016. Only 6.1% of patients received second-line therapy after CPAP discontinuation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CPAP therapy was continued for at least a year by about 80% of patients. Because second-line therapies are rarely implemented, efforts are needed to ensure CPAP persistence by considering the factors that influence it. It is also crucial to raise awareness of alternative therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration number<\/jats:title>\n                    <jats:p>NA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11325-025-03417-w","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T16:55:23Z","timestamp":1752771323000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Real-world status of continuous positive airway pressure (CPAP) persistence in patients with sleep apnea syndrome (SAS): a retrospective longitudinal study of administrative claims data in Japan"],"prefix":"10.1007","volume":"29","author":[{"given":"Hiroyuki","family":"Takahashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiori","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Nakajima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruriko","family":"Koto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5405-9073","authenticated-orcid":false,"given":"Hideaki","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"issue":"7","key":"3417_CR1","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1002\/alr.23079","volume":"13","author":"JL Chang","year":"2023","unstructured":"Chang JL, Goldberg AN, Alt JA et al (2023) International consensus statement on obstructive sleep apnea. 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This has been updated to CC BY accordingly.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This article does not contain any studies with human or animal subjects performed by any of the authors.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Because the data used in this study came from a large health insurance claims database and were fully anonymized, there was no need for informed consent from individual patients or approval from the Institutional Review Board (IRB).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Hiroyuki Takahashi, Shiori Yoshida, Akihiro Nakajima, and Ruriko Koto are employees of Teijin Pharma Limited. Shiori Yoshida, Akihiro Nakajima and Ruriko Koto hold stock in Teijin Limited. Hideaki Nakayama has received consulting fees from Teijin Pharma Limited and is affiliated with a department of somnology that receives support from Philips Japan and Koike Medical Co., LTD.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"245"}}