0538 Healthcare Resource Utilization in Treated Obstructive Sleep Apnea Patients with Comorbid Insomnia

Abstract Introduction Insomnia and obstructive sleep apnea (OSA), comorbidly known as COMISA, are the two most common sleep disorders, with each impairing treatment efficacy for the other. Real-world studies on treatment of patients with COMISA are lacking, thus this study aimed to examine the clinical and economic impact of treating OSA with positive airway pressure (PAP) therapy in this population. Methods This retrospective study linked administrative claims data to PAP device usage data for newly diagnosed OSA patients initiating PAP (index date) between January 2015 and April 2019. Adults with evidence of insomnia (insomnia prescription fill or insomnia ICD-9/10 diagnosis code) in the year prior and in the two-year period after index were included. Inverse probability of treatment weighting and Wilcoxon rank-sum tests were used to compare healthcare resource utilization (HCRU) over 2 years across varying levels of PAP adherence. Results From a sample of 26,965 COMISA patients, 28% met the criteria for consistently-adherent, 44% were intermediately-adherent, and 28% were non-adherent to PAP therapy over 2 years after index. The majority of intermediately-adherent patients had consistent PAP use in the first year of therapy, with decreased use in the second year. Consistently-adherent patients had fewer emergency room (ER) visits per patient than intermediately-adherent patients or non-adherent patients (year 1: 0.49 vs 0.59 P 0.001, vs 0.68 P 0.001; year 2: 0.46 vs 0.54 P 0.001, vs. 0.60 P 0.001). Consistently-adherent patients also had fewer all-cause hospitalizations per patient than intermediately- and non-adherent patients in both follow-up years (year 1: 0.10 vs 0.15 P 0.001, vs. 0.14 P 0.001; year 2: 0.09 vs 0.12 P 0.001, vs. 0.13 P 0.001). Based on major diagnostic category (MDC) codes, consistently-adherent patients saw the largest reductions in hospitalizations related to the respiratory, circulatory, nervous, and hepatobiliary systems, as well as those for alcohol/drug use or induced mental disorders. Conclusion This study showed reductions in all-cause hospitalizations and ER visits for COMISA patients who were consistently-adherent to PAP therapy over 2 years compared to those with lower adherence. PAP therapy is one facet of COMISA treatment that, if adhered to, can improve health outcomes. Support (if any) ResMed