Among 31,236 active-duty U.S. military personnel with OSA, 85% initiated PAP therapy within 12 months, with women having similar times to treatment as men but higher risk of inpatient and ED visits.
Cohort (n=31,236)
Yes
Do patterns of OSA-related health encounters and care delivery differ between men and women in the U.S. Military Health System?
While time to OSA treatment initiation is similar between sexes in the U.S. military, women have a higher risk of OSA-related inpatient and ED visits, highlighting potential differences in disease trajectory or management needs.
Abstract Background The patient journey is increasingly recognized as a core aspect of high-quality, patient-centered care. This study sought to describe the obstructive sleep apnea (OSA) patient journey within the U.S. Military Health System (MHS) and compare OSA care delivery between men and women. We hypothesized that patterns of OSA-related health encounters would differ between men and women. Methods Data were derived from the MHS Data Repository (2016-2021). Inclusion criteria were active-duty service members (SMs), ages 18-64 years, with 12 months continuous enrollment in TRICARE Prime before and after OSA diagnosis (index date). OSA was defined as a diagnostic sleep test (in-lab or at home) followed by a confirmatory OSA diagnosis within six months. Outcomes of interest included OSA referral source, treatment initiation (positive airway pressure PAP), and OSA-related healthcare encounters including outpatient encounters, inpatient stays, and emergency department (ED) visits. Descriptive statistics (median days from index) were used to characterize patterns of care (“journey”), stratified by sex. Between-groups differences (men vs women) were assessed using standardized mean differences (SMD). Results Participants included 31,236 active-duty SMs with OSA. Most participants (81.9%) were between 18-44 years old (7.0 % women). Most OSA care was initiated by MDs (67.8%) including sleep specialists (37.6%). The most common comorbidities were fibromyalgia (18.6%) and hyperlipidemia (13.5%). Within 12 months following OSA diagnosis, 97.5% of participants had 1 outpatient OSA encounter. Eighty-five percent of participants (n = 26,586) initiated PAP therapy within 12 months (median time to treatment=39 days). Only two percent of participants (n = 625) had 1 or more OSA-related inpatient stays (median time to first inpatient stay=163 days). Based on SMDs, no between-groups differences (men vs women) were observed in time to treatment initiation or time to first OSA-related outpatient encounter. However, women were at increased risk for OSA-related inpatient stays and OSA-related emergency department (ED) visits. Conclusions Within the MHS, no sex differences in quality of OSA care, including PAP initiation, time to PAP initiation, or time to first OSA-related outpatient encounter, were observed. However, women were more likely to experience OSA-related inpatient stays and ED visits. Future research should seek to optimize the OSA patient journey and improve health, economic, and military outcomes within the MHS. This abstract is funded by: DoD HT94022210006
Wickwire et al. (Fri,) conducted a cohort in Obstructive sleep apnea (OSA) (n=31,236). Female sex vs. Male sex was evaluated on OSA referral source, treatment initiation, and OSA-related healthcare encounters (outpatient, inpatient, ED visits). Among 31,236 active-duty U.S. military personnel with OSA, 85% initiated PAP therapy within 12 months, with women having similar times to treatment as men but higher risk of inpatient and ED visits.