A79-14 Impact of Positive Airway Pressure Therapy on Healthcare Resource Use in Patients With Obstructive Sleep Apnea and Treatment-Resistant Hypertension

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