Impact of Positive Airway Pressure Therapy on Health Care Resource Use in Patients With OSA and Coronary Artery Disease.

Abstract

OSA is associated with coronary artery disease (CAD) risk. This study examined the impact of positive airway pressure (PAP) therapy adherence on health care resource use (HCRU) in patients with CAD and newly diagnosed OSA. Is adherence to PAP therapy associated with reduced HCRU in patients with CAD and OSA? This retrospective analysis linked administrative claims to objective PAP use data (ResMed AirView) for adults (≥ 18 years of age) with CAD who received a new diagnosis of OSA. Two-year adherence was defined by the number of 90-day time frames in which adherence criteria were met. Inverse probability of treatment weighting was applied to assess primary outcomes of emergency room (ER) visits and hospitalizations 1 and 2 years after the index date. Thirty-two thousand nine hundred eleven patients were included (34.9% female; mean age, 60.9 years). Compared with adherent patients, nonadherent patients were slightly younger, more commonly female, and had higher prevalence of severe obesity and comorbidities. Compared with nonadherent patients, adherent patients made significantly fewer ER visits (-26% and -24%; P < .001) and all-cause hospitalizations (-35% and -39%; P < .001) in years 1 and 2, respectively. HCRU for intermediately adherent patients fell between that of adherent and nonadherent patients. After risk adjustment, the threshold for minimum nightly PAP use to derive a significant HCRU benefit was < 3 h/night for all outcomes and periods. A 4.7% to 5.9% reduction in HCRU rates with each additional hour per night of PAP use was noted. In real-world patients with CAD and newly diagnosed OSA, PAP therapy adherence was associated with lower HCRU. These findings strongly support the importance of diagnosing and treating OSA in these patients.