Using and adhering to positive airway pressure therapy was associated with fewer inpatient and overall acute care visits and a lower likelihood of having costs from those visits among patients with moderate or severe obstructive sleep apnea.
Using and adhering to positive airway pressure (PAP) therapy was associated with fewer inpatient and overall acute care visits and a lower likelihood of having costs from those visits among patients with moderate or severe obstructive sleep apnea (OSA).
PAP therapy, which prevents the collapse of the airway during sleep, has been shown to reduce the medical risks of OSA, but some patients have difficulty adhering to the therapy long term. A study recently published in the Journal of Clinical Sleep Medicine examined daily PAP usage data, which were uploaded automatically to the cloud by the PAP equipment, for 1098 patients with moderate or severe OSA. Because all were members of a large integrated healthcare system, the researchers linked the sleep data with patients’ healthcare utilization and costs. Utilization was measured by the number of overall acute care visits, which consisted of inpatient hospitalizations, emergency department (ED) visits, and inpatient observation visits.
Most (60.6%) of the participants were considered to be adherent to PAP therapy based on the CMS criteria of using PAP more than 4 hours per night for 70% or more of the nights in the 18-month study period. Those who were adherent had a lower mean (SD) Charlson Comorbidity Index score than those who were not (2.8 [1.9] vs 3.2 [1.77]; P = .004) and were less likely to have ischemic heart disease, heart failure, hypertension, diabetes, and chronic kidney disease.
The researchers found a negative association between PAP usage and both inpatient and overall acute care visits. For every increase in use of 1 hour per night, there was an 8% decrease in inpatient visits (rate ratio [RR], 0.92; 95% CI, 0.86-0.98) and a 4% decrease in overall visits (RR, 0.96; 95% CI, 0.92-0.99). Patients who were considered adherent to PAP had significantly lower inpatient (RR, 0.62; 95% CI, 0.44-0.87) and overall (RR, 0.74; 95% CI, 0.61-0.90) visits.
Increasing PAP use was associated with a lower likelihood of having positive cost incurred to the health system from inpatient (odds ratio [OR], 0.93; 95% CI, 0.86-1.00) and overall acute care (OR, 0.94; 95% CI, 0.89-1.00) visits, but it was not associated with the amount of the cost when such a cost occurred. These relationships were observed when comparing adherent and nonadherent patients but not when comparing patients using PAP for more than 6 hours per night with those using it just 0 to 2 hours per night.
The study authors suggested that treatment of OSA with PAP could decrease healthcare utilization by a variety of mechanisms, including by improving symptoms of daytime sleepiness and thereby reducing the likelihood of a motor vehicle accident related to sleepiness. PAP use to treat OSA may also help reduce the severity of some comorbidities, such as hypertension or arrythmia.
They recommended that future research assess a broader range of healthcare costs, including postacute and ambulatory costs, and use data from a longer study period, which can be made possible via technological advances in PAP equipment that allow for data to be recorded and shared.
“As patients and healthcare systems evaluate methods to reduce medical costs, treating OSA effectively should be considered part of the solution,” they concluded. “Researchers and clinicians in the field of sleep medicine should continue to focus on outcomes-based research to ensure that patients, payers, and hospital systems all understand the value that treatment of sleep disorders provides.”
Kirsch DB, Yang H, Maslow AL, Stolzenbach M, McCall A. Association of positive airway pressure use with acute care utilization and costs. J Clin Sleep Med. 2019;15(9):1243-1250. doi: 10.5664/jcsm.7912.