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. 2022 Dec 1;18(12):2739-2744.
doi: 10.5664/jcsm.10196.

Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease

M Doyinsola Bailey  1 , Emerson M Wickwire  2   3 , Virend K Somers  4 , Jennifer S Albrecht  1
Affiliations

Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease

M Doyinsola Bailey et al. J Clin Sleep Med. .

Abstract

Study objectives: Obstructive sleep apnea (OSA) is underdiagnosed and undertreated among patients hospitalized with comorbid cardiovascular disease (CVD). Treatment of OSA may reduce health care utilization, but benefits of continuous positive airway pressure (CPAP) therapy are related to adherence. Benefits of CPAP among hospitalized individuals with OSA and CVD have not been well studied. We evaluated the effect of CPAP adherence on 30-day hospital readmission among Medicare beneficiaries hospitalized with OSA and CVD.

Methods: We conducted a retrospective cohort study of Medicare beneficiaries aged ≥ 65 years with pre-existing CVD who were newly diagnosed with OSA between 2009 and 2013, initiated CPAP, and were hospitalized. CPAP adherence was defined as nonadherent, partially adherent, or highly adherent based on the number of machine charges (< 4, 4-12, and > 12, respectively) over 25 months of follow-up. The primary outcome was 30-day hospital readmission.

Results: Among 1,301 beneficiaries meeting study criteria, the 30-day readmission rate was 10.2%. In adjusted models and compared to patients with low CPAP adherence, those with high adherence had lower odds of 30-day readmission (odds ratio 0.41; 95% confidence interval 0.24-0.70). The protective effect of high CPAP adherence on 30-day readmission was significant among beneficiaries with heart failure (odds ratio 0.50; 95% confidence interval 0.16, 0.79), but not among those with other CVD.

Conclusions: In this nationally representative sample of older adults with CVD and comorbid OSA, high CPAP adherence was associated with lower odds of 30-day readmission. These results highlight the importance of screening for and treating OSA among individuals with CVD.

Citation: Bailey MD, Wickwire EM, Somers VK, Albrecht JS. Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease. J Clin Sleep Med. 2022;18(12):2739-2744.

Keywords: 30-day readmission; Medicare beneficiaries; cardiovascular disease; continuous positive airway pressure; multimorbidity; obstructive sleep apnea.

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Conflict of interest statement

All authors have seen and approved this manuscript. Work for this study was performed at the University of Maryland School of Medicine, Baltimore, MD. This study was funded by an investigator-initiated grant and a diversity supplement from the American Academy of Sleep Medicine Foundation (Albrecht, PI). E.M.W. and J.S.A.’s institution has received research funding from the Department of Defense, Merck, and ResMed. E.M.W. served as a scientific consultant for DayZz, Eisai, Merck, and Purdue and is an equity shareholder in WellTap. V.K.S. reports no funding. The authors report no conflicts of interest.

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