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. 2023 Jul 18;12(14):e028733.
doi: 10.1161/JAHA.122.028733. Epub 2023 Jul 8.

Positive Airway Pressure Therapy Adherence and Health Care Resource Use in Patients With Obstructive Sleep Apnea and Heart Failure With Preserved Ejection Fraction

Peter A Cistulli  1   2 , Atul Malhotra  3 , Kate V Cole  4 , Anita S Malik  4 , Jean-Louis Pépin  5 , Fatima H Sert Kuniyoshi  4   6 , Adam V Benjafield  7 , Virend K Somers  6 ; medXcloud group *
Collaborators, Affiliations

Positive Airway Pressure Therapy Adherence and Health Care Resource Use in Patients With Obstructive Sleep Apnea and Heart Failure With Preserved Ejection Fraction

Peter A Cistulli et al. J Am Heart Assoc. .

Abstract

Background Obstructive sleep apnea (OSA) is common in heart failure with preserved ejection fraction (HFpEF). However, current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in HFpEF. This study assessed the association between adherence to PAP therapy and health care resource use in patients with OSA and HFpEF. Methods and Results Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to determine associations between PAP adherence and a composite outcome including hospitalizations and emergency room visits. One-year PAP adherence was based on an adapted US Medicare definition. Propensity score methods were used to create groups with similar characteristics across PAP adherence levels. The study cohort included 4237 patients (54.0% female, mean age 64.1 years); 40% were considered adherent to PAP therapy (30% intermediate adherent, 30% nonadherent). In the matched cohort, PAP-adherent patients had fewer health care resource use visits than nonadherent patients, a 57% decrease in hospitalizations, and a 36% decrease in emergency room visits versus the year before PAP initiation. Total health care costs were lower in adherent patients than nonadherent patients ($12 732 versus $15 610, P<0.001). Outcomes for intermediately adherent patients were most similar to those for nonadherent patients. Conclusions Treating OSA with PAP therapy in patients with HFpEF was associated with a reduction in health care resource use. These data highlight the importance of managing concomitant OSA in patients with HFpEF, and the need for strategies to enhance PAP adherence in this population.

Keywords: health care resource use; heart failure; obstructive sleep apnea; positive airway pressure adherence.

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Figures

Figure 1
Figure 1. Effect of positive airway pressure adherence on mean number of composite hospitalizations and emergency room visits.
Figure 2
Figure 2. Health care resource use 1 year before and 1 year after initiating positive airway pressure (PAP) therapy.
ER indicates emergency room; and SMD, standardized mean difference.
See this image and copyright information in PMC

Comment in

  • Breathe Better and Preserve Heart.
    Healy WJ, Khayat R, Kwon Y. Healy WJ, et al. J Am Heart Assoc. 2023 Jul 18;12(14):e030806. doi: 10.1161/JAHA.123.030806. Epub 2023 Jul 8. J Am Heart Assoc. 2023. PMID: 37421298 Free PMC article. No abstract available.

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