Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA

Abstract

Objective: Growing evidence supports that patients with chronic obstructive pulmonary disease (COPD) and coexisting obstructive sleep apnea (OSA) have poor prognosis. This association is described as overlap syndrome. Positive airway pressure (PAP) therapy is now the preferred treatment for OSA. We hypothesized that use of PAP therapy in elderly patients with overlap syndrome would be associated with lower healthcare utilization.

Methods: In this retrospective cohort study, we analyzed data from 5% national sample of fee-for-service Medicare beneficiaries with a diagnosis of COPD who were newly started on PAP therapy in 2011. We examined the effect of PAP therapy on emergency room (ER) visits and hospitalizations for all-cause and COPD-related conditions in the 1 year pre- and 1 year post-initiation of PAP therapy.

Results: In year 2011, we identified 319 patients with overlap syndrome who were new users of PAP therapy. In this cohort of patients, hospitalization rates for COPD-related conditions were significantly lower in the 1 year post-initiation of PAP therapy compared to the 1-year pre-initiation period (19.4 vs 25.4%, P value = 0.03). However, ER visits (for any cause or COPD-related conditions) and hospitalization rates for any cause did not differ significantly in the pre- and post-initiation periods. PAP therapy was more beneficial in older adults, those with higher COPD complexity, and those with three or more comorbidities.

Conclusion: Initiation of PAP therapy in elderly patients with overlap syndrome is associated with a reduction in hospitalization for COPD-related conditions, but not for all-cause hospitalizations and ER visits.

Keywords: COPD; Hospitalization and healthcare utilization; OSA; Overlap syndrome; PAP.

Figure 1. Flow chart showing the cohort selection

^1. Of these 319 COPD patients started on PAP therapy, 292 (91.5%) patients had a visit for OSA during the same year. Abbreviations: ICD-9 = International Classification of Diseases, Ninth revision; COPD = Chronic Obstructive Pulmonary Disease; PAP = Positive Airway Pressure; HMO = Health Maintenance Organization; CMS = Centers for Medicare and Medicaid Services.

Figure 2. COPD-related hospitalizations in patients with Overlap Syndrome in the one year pre- and one year post-initiation of PAP therapy*

*Failure rates were estimated by Kaplan Meier method.