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October 03, 2022
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CPAP adherence may reduce rehospitalization in adults with obstructive sleep apnea, CVD

Fact checked byKristen Dowd
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New data have linked more consistent use of CPAP treatment to lower risk for rehospitalization in older adults with obstructive sleep apnea and cardiovascular disease.

“Cardiovascular disease is the No. 1 killer of adults in the U.S. and worldwide. From a public health perspective, it is vital that we do everything we can to reduce the burden of heart disease,” Jennifer S. Albrecht, PhD, associate professor in the department of epidemiology and public health at the University of Maryland School of Medicine in Baltimore, told Healio. “Our past work demonstrated that adherence to CPAP therapy was associated with reduced risk of new cardiovascular events and reduced inpatient health care utilization among Medicare beneficiaries with OSA and CVD. In this study, we wanted to examine the effect of CPAP on 30-day hospital readmissions.”

Woman using CPAP
Source: Adobe Stock
Jennifer S. Albrecht

In this retrospective cohort study, Albrecht and colleagues evaluated Medicare beneficiaries aged 65 years or older with preexisting CVD who were newly diagnosed with OSA between 2009 and 2013, had initiated CPAP therapy and had at least one hospitalization. Of the 1,301 patients included in the analysis, the mean age was 73.4 years, 53% were men and 87% were white. Overall, 33% of patients had low adherence, 38% had partial adherence and 29% had high adherence.

During the 2 years after CPAP initiation, the overall 30-day hospital readmission rate was 10.2%. In unadjusted models, the likelihood for hospital readmission was lower for patients with partial (OR = 0.79; 95% CI, 0.53-1.18) and high adherence (OR = 0.38; 95% CI, 0.22-0.65), as compared with those with low adherence. However, after adjustment for demographic and clinical characteristics, only patients in the high adherence group were significantly less likely than those in the low adherence group to be rehospitalized (adjusted OR = 0.41; 95% CI, 0.24-0.7).

In adjusted analyses, the researchers also found that high CPAP adherence, as compared with low adherence, was associated with lower likelihood for 30-day readmission among patients with heart failure (aOR = 0.5; 95% CI, 0.16-0.79). A similar effect was seen among patients without heart failure, but the relationship was not statistically significant.

“Among this national sample of Medicare beneficiaries, we found a very large protective effect of OSA treatment. High adherence to CPAP was associated with approximately 60% reduction in 30-day hospital readmission. This is a staggering reduction,” Albrecht said. “We were also interested to see that the effect of high adherence to CPAP was significant among patients with heart failure, but not among patients with other types of CVD.”

Additionally, results from a sensitivity analysis looking at 60-day hospital readmissions showed that the likelihood for readmission was lower among patients with partial (OR = 0.68; 95% CI, 0.47-0.94) and high adherence (OR = 0.49; 95% CI, 0.32-0.76), as compared with those with low adherence.

“OSA is a common and costly medical condition that is very highly underdiagnosed, especially among older adults. Our results highlight the importance of screening for and treating OSA among older adults hospitalized with CVD. OSA is highly treatable, and treatment improves quality of life. Treatment can also reduce 30-day readmissions, a major driver of health care costs in the U.S,” Albrecht said.

Looking ahead, the researchers would like to further evaluate the benefits of screening and treatment.

“Our most important future direction is to screen for and treat OSA among hospitalized individuals with preexisting CVD. Second, we observed a strong protective effect of CPAP on hospital readmission among Medicare beneficiaries co-diagnosed with OSA and heart failure. This finding should be investigated in future, larger studies,” Albrecht said.

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