0654 Obstructive Sleep Apnea in Older Adults: Geographic Variation in CPAP Treatment

Abstract

Introduction Obstructive sleep apnea (OSA) is prevalent and consequential among older adults. Positive airway pressure (PAP) is likely to reduce associated morbidity, but adherence is inconsistent. Regional treatment variations that may reflect addressable differences in care are not sufficiently studied. We examined geographic variations in PAP treatment among older US adults. Methods A representative 5% sample of all Medicare beneficiaries, age 65+, enrolled in fee-for-service program in 2013 was analyzed. OSA diagnosis was defined by ICD-9 codes. PAP treatment was identified by HCPCS codes. Treatment adherence was defined as ≥2 HCPCS claims for PAP supplies on separate months. We examined state-specific proportions of Medicare beneficiaries with OSA who obtained PAP and showed adherence. Maps were created to represent state-specific proportions of beneficiaries who were treated and adherent, by quantiles. To examine more granular regional variations, we created maps representing hospital referral region (HRR)-specific proportions of treated among diagnosed, and adherent among treated. Scatterplots were used to identify the relationship between proportions of PAP treatment and adherence, by state. Results For the state-level data, PAP treatment and adherence rates were between 54%-87% and 59%-81%, respectively. Midwest states had higher CPAP treatment proportions (>80%), while Northeast, Southwest and Southern states had CPAP treatment rates <73%. State-level CPAP adherence showed similar patterns, with lowest rates in southern states and California (<70%). Within-state variability of treatment patterns were observed, especially along the east and the west coasts. A scatterplot revealed that state-level CPAP treatment and adherence rates were linearly correlated, with Washington D.C., NY and NJ ranked lowest. In contrast, MT, ND and VT had the highest treatment and adherence rates. Conclusion These data show substantial state-level and regional variability of CPAP treatment and adherence among Medicare beneficiaries. Some geographic areas may merit prioritization in efforts to improve OSA treatment and adherence. Support This study was supported by The American Sleep Medicine Foundation Strategic Research Award 115-SR-15