Adherence to PAP therapy in patients with OSA and treatment-resistant hypertension reduced cardiovascular-related visits compared to non-adherence (5.0% vs 7.7%; RR 0.65; 95% CI 0.53-0.80; P=0.004).
Observational (n=7,612)
Does adherence to PAP therapy reduce healthcare resource use in adults with newly diagnosed OSA and treatment-resistant hypertension?
In patients with treatment-resistant hypertension and newly diagnosed OSA, adherence to PAP therapy is associated with significantly reduced healthcare resource use, including hospitalizations and cardiovascular-related visits.
Effect estimate: RR 0.65 (95% CI 0.53-0.80)
Absolute Event Rate: 5% vs 7.7%
p-value: p=0.004
Abstract Rationale Untreated Obstructive sleep apnea (OSA) can negatively impact cardiovascular health and frequently coexists with hypertension. Although positive airway pressure (PAP) therapy has moderate effects on blood pressure, the evidence demonstrates more pronounced reductions in patients with treatment-resistant hypertension (TRH). This study investigated the effects of adherence to PAP therapy on health care resource use (HCRU) in patients with TRH. Methods This retrospective study linked data from administrative claims from 2014 to 2023, objective PAP device use (via AirViewTM), and electronic medical records. Adults (≥18 years) with newly diagnosed OSA and set up on PAP, with comorbid TRH ≥4 antihypertensive medications (including a diuretic) or ≥ 3 antihypertensive medications (including a diuretic) and a blood pressure measurement with systolic ≥130mmHg or diastolic ≥80mmHg were included. Patients with pre-existing heart failure were excluded. PAP adherence was defined by the number of 90-day quarters in which patients met CMS compliance criteria (≥4 hours/night on 70% of nights in a 30-day period) over 1 year: adherent (4 quarters), intermediately adherent (1-3 quarters), non-adherent (0 quarters). Inverse probability of treatment weighting (IPTW) was used to balance adherence groups on baseline characteristics (including demographics, clinical characteristics, and medication counts) to assess the association of adherence with HCRU in the first year of PAP. Results There were 7, 612 patients included (46% female, mean age: 57 years). Other cardiometabolic conditions, including coronary artery disease (23%), type 2 diabetes (48%), and hyperlipidemia (74%) were common. Over 1 year, 37. 9%, 29. 9%, and 32. 2% were adherent, intermediately adherent, and non-adherent to PAP therapy, respectively. After applying IPTW, groups were well balanced at baseline. Adherent patients had significantly fewer all-cause ER visits (adherent: 0. 61 vs. intermediately adherent: 0. 74, p = 0. 001; vs. non-adherent: 0. 83, p 0. 001) and all-cause hospitalizations (adherent: 0. 13 vs. intermediately adherent: 0. 20, p 0. 001; vs. non-adherent: 0. 23, p 0. 001). Adherence to PAP was also associated with 35% lower risk (risk ratio: 0. 65, 95% CI: 0. 53-0. 80) of any cardiovascular-related visit, relative to non-adherence (5. 0% vs. 7. 7%, p = 0. 004). Costs for hospitalizations (adherent: 1, 944 vs. intermediately adherent: 2, 997, p 0. 001; vs. non-adherent: 3, 196, p 0. 001) and ER visits (adherent: 608 vs. intermediately adherent: 755, p 0. 001; vs. non-adherent: 882, p 0. 001) were significantly lower for adherent patients. Conclusions In real-world patients with TRH and newly diagnosed OSA, adherence to PAP therapy was associated with reduced HCRU in the first year. These findings highlight the importance of diagnosing and treating OSA in clinical practice to reduce healthcare burden. This abstract is funded by: Resmed
Kuniyoshi et al. (Fri,) conducted a observational in Obstructive sleep apnea and treatment-resistant hypertension (n=7,612). Positive airway pressure (PAP) therapy adherence vs. Non-adherence to PAP therapy was evaluated on Any cardiovascular-related visit (RR 0.65, 95% CI 0.53-0.80, p=0.004). Adherence to PAP therapy in patients with OSA and treatment-resistant hypertension reduced cardiovascular-related visits compared to non-adherence (5.0% vs 7.7%; RR 0.65; 95% CI 0.53-0.80; P=0.004).