Adherence to positive airway pressure therapy in patients with OSA and hypertension significantly reduced the risk of cardiovascular-related healthcare utilization events compared to non-adherence (RR 0.77; 95% CI 0.74-0.81).
Cohort (n=283,938)
Does adherence to positive airway pressure (PAP) therapy reduce healthcare resource utilization in adults with newly diagnosed obstructive sleep apnea and comorbid hypertension?
In patients with obstructive sleep apnea and comorbid hypertension, greater adherence to positive airway pressure therapy is associated with significantly lower healthcare utilization, including cardiovascular-related events.
Effect estimate: RR 0.77 (95% CI 0.74-0.81)
Abstract Introduction Obstructive sleep apnea (OSA) and hypertension frequently coexist with some estimates indicating that 50% of those with OSA are also affected by hypertension. Positive airway pressure (PAP) therapy has been associated with modest improvements in blood pressure. This analysis investigated the association between adherence to PAP therapy with healthcare resource utilization (HCRU) in newly diagnosed OSA patients with comorbid hypertension. Methods This retrospective cohort study analyzed administrative claims from 2014 to 2023, linked with objective PAP therapy device usage data. Adults (≥18 years) with hypertension (based on ICD-9/10 codes) and newly diagnosed OSA who initiated PAP therapy were included. PAP therapy adherence was defined by the number of 90-day quarters in which a patient 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, and non-adherent (0 quarters). HCRU in the first year of PAP use was compared across adherence groups, after applying inverse probability of treatment weighting (IPTW) to balance groups on baseline characteristics. Results Among 283,938 OSA PAP-treated patients (44% female, mean age: 55 years), 67% met initial 90-day CMS compliance. Increasing adherence was associated with being male, older, commercially insured, and with lower comorbidity burden. Over 1 year, 72% were defined as at least intermediately adherent. After IPTW adjustment, adherent patients had significantly lower per-person rates of all-cause ER visits (0.56 vs. intermediately adherent: 0.64, p 0.001; vs. non-adherent: 0.72, p 0.001) and all-cause hospitalizations (0.13 vs. intermediately adherent: 0.18, p 0.001; vs. non-adherent: 0.19, p 0.001). There was a 23% reduction in the risk of any cardiovascular-related HCRU event (cardiovascular-related ER visit or hospitalization) for adherent patients, relative to non-adherent patients (RR: 0.77, 95% CI: 0.74-0.81). Hospitalization and ER visit costs were also significantly lower for adherent compared to intermediately or non-adherent patients. Conclusion In real-world patients with OSA and comorbid hypertension, greater PAP adherence was associated with significantly lower healthcare utilization and costs. Emphasis on screening, diagnosing and treating OSA (including patient adherence support) in patients with hypertension may lead to better outcomes in this population. Support (if any) Resmed
Sterling et al. (2026) conducted a cohort in Obstructive sleep apnea (OSA) and comorbid hypertension (n=283,938). Positive airway pressure (PAP) therapy adherence vs. Intermediately adherent (1-3 quarters) or non-adherent (0 quarters) was evaluated on Any cardiovascular-related healthcare resource utilization event (cardiovascular-related ER visit or hospitalization) (RR 0.77, 95% CI 0.74-0.81). Adherence to positive airway pressure therapy in patients with OSA and hypertension significantly reduced the risk of cardiovascular-related healthcare utilization events compared to non-adherence (RR 0.77; 95% CI 0.74-0.81).