Positive airway pressure use impacts number of hospital, ER visits

Key takeaways:

• Positive airway pressure therapy use is linked to health care utilization.
• Hospitalizations and emergency room visits went down with longer device usage per night.

Using positive airway pressure therapy each night lowered the rate of hospitalizations and emergency room visits in patients with obstructive sleep apnea, according to results published in Annals of the American Thoracic Society.

“The results showed a consistent dose-response relationship between [positive airway pressure (PAP)] usage hours and all-cause hospitalizations and ER visits over 2 years of follow-up,” Atul Malhotra, MD, professor of medicine at University of California, San Diego, and colleagues wrote.

“These benefits were observed even when PAP usage was [1 to 3] hours per night, which is below the traditionally defined minimum usage threshold of 4 hours per night,” Malhotra and colleagues added.

The researchers assessed 179,188 adults (mean age, 52.5 years; 40.5% women; 51.5% with obesity) newly diagnosed with OSA between June 2014 and April 2018, and treated with PAP therapy (AirSense 10, ResMed) to determine how daily device usage impacts health care utilization, or the number of hospitalizations and emergency room visits, at 3, 12 and 24 months following the start of therapy.

Researchers used a data set that included both administrative medical/pharmacy claims and patient PAP usage to evaluate the relationship between the two factors.

Patients frequently used PAP for 3 to 7 hours a night during each of the follow-up points. According to researchers, PAP usage of 8 hours or longer was rarely reported in all three visits.

Researchers found that PAP therapy provided a significant benefit to patients if used for at least 3 to 4 hours a night after risk adjustment, with greater reductions in hospitalizations and ER visits seen with longer usage up until 9 hours per night.

Each additional hour of PAP therapy resulted in a 5.1% to 9.7% decrease in predicted event rates, and researchers found that this translated into a predicted absolute drop of 3 to 11 hospitalizations per 1,000 patients and 9 to 48 ER visits per 1,000 patients.

Notably, patients could avert ER visits with at least 1 to 2 hours of PAP usage per night, and this was seen during each of the follow-up visits.

Researchers further found that longer use of PAP was linked to fewer hospitalizations and ER visits at the 12-month visit after accounting for adherence to prescribed statins, antihypertensives and long-acting beta-agonists.

“These data could help inform evidence-based guidelines for PAP usage and reimbursement until more definitive data are available,” Malhotra and colleagues wrote. “On the basis of CMS adherence criteria alone, the current data have the potential to impact on medical decision-making for OSA patients worldwide, possibly allowing a greater number of individuals to benefit from even low-level usage of CPAP therapy.”