Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States

Sterling, K.L.; Cistulli, Peter A.; Linde-Zwirble, Walter; Malik, Anita; Benjafield, Adam; Malhotra, Atul; Cole, Kate V; Emami, Hussein; Woodford, Caleb; More, Suyog; Armitstead, Jeff; Nuñez, Carlos M.; Reutrakul, Sirimon; Pépin, Jean-Louis

doi:10.5664/jcsm.10388

Cited by 15 publications

(11 citation statements)

References 43 publications

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“…The benefits of early diagnosis and treatment of sleep apnoea in individuals with diabetes mellitus are increasingly being recognized, 38 as of course are the benefits of treating diabetes. Furthermore, adherence to positive airway pressure therapy for the treatment of OSA has recently been shown to improve control of type 2 diabetes and to decrease health‐related costs 39 . The current challenge in this large, minimally symptomatic population is to improve access to OSA diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, adherence to positive airway pressure therapy for the treatment of OSA has recently been shown to improve control of type 2 diabetes and to decrease health-related costs. 39 The current challenge in this large, minimally symptomatic population is to improve access to OSA diagnosis. The MJM diagnosis solution utilized in the current study has been validated against in-laboratory PSG and for use in the home as an ambulatory diagnostic tool over multiple nights of assessment.…”

Section: Discussionmentioning

confidence: 99%

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Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea

Martinot

Le-Dong²,

Borel

et al. 2023

Diabetes Obesity Metabolism

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AimTo determine the association between total sleep time (TST) spent in increased respiratory effort (RE) and the prevalence of type 2 diabetes in a large cohort of individuals with suspected obstructive sleep apnoea (OSA) referred for in‐laboratory polysomnography (PSG).Materials and MethodsWe conducted a retrospective cross‐sectional study using the clinical data of 1128 patients. Non‐invasive measurements of RE were derived from the sleep mandibular jaw movements (MJM) bio‐signal. An explainable machine‐learning model was built to predict prevalent type 2 diabetes from clinical data, standard PSG indices, and MJM‐derived parameters (including the proportion of TST spent with increased respiratory effort [REMOV [%TST]).ResultsOriginal data were randomly assigned to training (n = 853) and validation (n = 275) subsets. The classification model based on 18 input features including REMOV showed good performance for predicting prevalent type 2 diabetes (sensitivity = 0.81, specificity = 0.89). Post hoc interpretation using the Shapley additive explanation method found that a high value of REMOV was the most important risk factor associated with type 2 diabetes after traditional clinical variables (age, sex, body mass index), and ahead of standard PSG metrics including the apnoea‐hypopnea and oxygen desaturation indices.ConclusionsThese findings show for the first time that the proportion of sleep time spent in increased RE (assessed through MJM measurements) is an important predictor of the association with type 2 diabetes in individuals with OSA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea

Martinot

Le-Dong²,

Borel

et al. 2023

Diabetes Obesity Metabolism

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“…Adherence to PAP therapy in the 2 years after device setup was defined on the basis of an extension of the CMS criteria for 90‐day compliance, as previously described. 28 , 29 , 30 , 31 CMS considers a patient compliant if he/she has PAP device use of ≥4 hours/night for ≥70% of nights in a 30‐day period within a 90‐day window. Those who met these criteria in all 8, 1 to 7, or 0 of the follow‐up quarters were defined as being adherent, intermediate, and nonadherent to PAP therapy, respectively.…”

Section: Methodsmentioning

confidence: 99%

Association Between Sleep Apnea Treatment and Health Care Resource Use in Patients With Atrial Fibrillation

Sterling,

Alpert,

Malik

et al. 2024

JAHA

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Background Obstructive sleep apnea (OSA) contributes to the generation, recurrence, and perpetuation of atrial fibrillation, and it is associated with worse outcomes. Little is known about the economic impact of OSA therapy in atrial fibrillation. This retrospective cohort study assessed the impact of positive airway pressure (PAP) therapy adherence on health care resource use and costs in patients with OSA and atrial fibrillation. Methods and Results Insurance claims data for ≥1 year before sleep testing and 2 years after device setup were linked with objective PAP therapy use data. PAP adherence was defined from an extension of the US Medicare 90‐day definition. Inverse probability of treatment weighting was used to create covariate‐balanced PAP adherence groups to mitigate confounding. Of 5867 patients (32% women; mean age, 62.7 years), 41% were adherent, 38% were intermediate, and 21% were nonadherent. Mean±SD number of all‐cause emergency department visits (0.61±1.21 versus 0.77±1.55 [ P =0.023] versus 0.95±1.90 [ P <0.001]), all‐cause hospitalizations (0.19±0.69 versus 0.24±0.72 [ P =0.002] versus 0.34±1.16 [ P <0.001]), and cardiac‐related hospitalizations (0.06±0.26 versus 0.09±0.41 [ P =0.023] versus 0.10±0.44 [ P =0.004]) were significantly lower in adherent versus intermediate and nonadherent patients, as were all‐cause inpatient costs ($2200±$8054 versus $3274±$12 065 [ P =0.002] versus $4483±$16 499 [ P <0.001]). All‐cause emergency department costs were significantly lower in adherent and intermediate versus nonadherent patients ($499±$1229 and $563±$1292 versus $691±$1652 [ P <0.001 and P =0.002], respectively). Conclusions These data suggest clinical and economic benefits of PAP therapy in patients with concomitant OSA and atrial fibrillation. This supports the value of diagnosing and managing OSA and highlights the need for strategies to enhance PAP adherence in this population.

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“…This is clinically relevant due to well-documented associations between OSA and several important neurocognitive, cardiovascular and metabolic comorbidities, including hypertension, cardiovascular disease, atrial fibrillation, diabetes, and even cancer (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In addition, undiagnosed and untreated OSA have been associated with major depressive disorder, reduced quality of life, and increased healthcare utilization (13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study

Gentina¹,

Gentina

B³

et al. 2023

Front. Neurol.

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Study objectivesThe prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study.MethodsEligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up.ResultsEnrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy.ConclusionSEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway.

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Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States

Cited by 15 publications

References 43 publications

Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea

Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea

Association Between Sleep Apnea Treatment and Health Care Resource Use in Patients With Atrial Fibrillation

Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study

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