{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:00:27Z","timestamp":1785387627178,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Adv. Respir. Med.","ARM"],"abstract":"<jats:p>Obstructive sleep apnea (OSA) is associated with increased cardiovascular, respiratory, and all-cause mortality, yet the long-term survival impact of continuous positive airway pressure (CPAP) remains contested, and treatment is usually analysed as a binary exposure rather than by the quality of the response achieved. In a single-centre cohort of 4368 adults referred for polysomnography and followed for 8\u201320 years (prespecified subgroup with apnea\u2013hypopnea index [AHI] \u2265 15, n = 2304), we applied cause-specific Cox and Fine\u2013Gray competing-risks models, together with machine-learning classifiers, to characterise all-cause, cardiovascular, and pulmonary mortality. CPAP was associated with reduced all-cause (hazard ratio [HR] 0.75), cardiovascular (HR 0.75), and pulmonary mortality (HR 0.54), with the benefit confined to severe OSA (HR 0.66) and absent in moderate disease (HR 0.95). Good responders showed a significant 34% reduction in all-cause mortality (HR 0.66), whereas poor responders showed no significant reduction. Nocturnal desaturation (time with oxygen saturation &lt; 90%) was the dominant independent predictor of pulmonary mortality, and baseline features predicted response category only moderately (macro-averaged AUC 0.76). Long-term CPAP confers a severity- and response-dependent survival benefit; nocturnal hypoxaemia is a key, modifiable driver of respiratory death.<\/jats:p>","DOI":"10.3390\/arm94040055","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:57:28Z","timestamp":1785254248000},"page":"55","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Who Really Benefits from CPAP? Disease Severity, Response Quality, and Long-Term Survival in Obstructive Sleep Apnea"],"prefix":"10.3390","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4635-2103","authenticated-orcid":false,"given":"Wojciech","family":"Kuczy\u0144ski","sequence":"first","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 6\/8 Mazowiecka Street, 92-215 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2228-8744","authenticated-orcid":false,"given":"Karol","family":"Pierzcha\u0142a","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 6\/8 Mazowiecka Street, 92-215 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1311-5704","authenticated-orcid":false,"given":"Weronika","family":"Bielska","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 6\/8 Mazowiecka Street, 92-215 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7694-9282","authenticated-orcid":false,"given":"Zuzanna","family":"Boczar","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 6\/8 Mazowiecka Street, 92-215 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Kudrycka","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 6\/8 Mazowiecka Street, 92-215 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Bia\u0142asiewicz","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 6\/8 Mazowiecka Street, 92-215 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ge, X., Han, F., Zhang, Y., Yang, T., Bai, C., and Guo, X. 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