Abstract Introduction First-line treatment for obstructive sleep apnea (OSA) is positive airway pressure (PAP). However, adherence is variable and uptake of alternate and emerging non-PAP therapies is unclear. The proportion of people diagnosed with OSA who do not commence or discontinue treatment and the influence of OSA severity on treatment patterns in the real-world setting has been minimally investigated. We aimed to characterize real-world treatment patterns in people with newly diagnosed OSA. Methods This retrospective study analyzed adults with newly diagnosed OSA (ICD-10-CM codes) in Optum Market Clarity, a de-identified database linking electronic health records with medical and pharmacy claims (2016-2024). Eligibility: apnea-hypopnea index (AHI) within 180 days of OSA index date and health plan enrollment ≥12 months before and after diagnosis. Treatment patterns were analyzed during the 12-month follow-up, stratified by OSA severity per AHI (events/h): mild (5- 15), moderate (15- 30), severe (30). Results 11,627 people with newly diagnosed OSA were included: mild (36%), moderate (27%) and severe (37%). Mean±SD age 57±14 years, 57% male, 63% commercial, 27% Medicare and 10% other/no insurance, with similar comorbidities across OSA severity categories. PAP was the most common initial prescribed therapy: 59% mild, 65% moderate and 72% severe (p 0.001). Rates of initial therapy with hypoglossal nerve stimulation (0.1%) and oral/dental appliances were low (1.1%). Many received no OSA-specific treatment: 40% mild, 33% moderate and 27% severe (p 0.001). Among PAP users, mean time from incident OSA diagnosis to first PAP device claim was 90±76 days, with 49% discontinuing therapy during the first year regardless of severity. Concomitant sleep-promoting agents were more frequently used in mild OSA (15%) compared to moderate (13%) and severe patients (12%, p 0.001); wakefulness-promoting agents were used by only 3%, with higher proportion in mild OSA (p=0.013). Conclusion In this large US cohort, PAP was the predominant initial therapy, with increasing use by OSA disease severity. However, high rates of non-treatment and PAP discontinuations across the OSA disease severity categories indicate that many people with OSA remain untreated. These novel findings underscore the need for targeted interventions to improve timely access, adherence, and long-term management of OSA. Support (if any) Apnimed, Inc.
Schmickl et al. (Fri,) studied this question.