Dose-Response Relationship between Obstructive Sleep Apnea Therapy Adherence and Healthcare Utilization

Abstract

Rationale Clear definition of optimal positive airway pressure therapy usage in patients with obstructive sleep apnea is not possible because of scarce data on the relationship between usage hours and major clinical outcomes. Objective To investigate the dose–response relationship between positive airway pressure usage and healthcare resource utilization and determine the minimum device usage required for benefit. Methods A linked data set combined deidentified payer-sourced administrative medical/pharmacy claims data from more than 100 U.S. health plans and individual patient positive airway pressure usage data. Eligible adults (age ⩾18 yr) had a new obstructive sleep apnea diagnosis between June 2014 and April 2018. All received positive airway pressure therapy (AirSense 10; ResMed) with claims data for ⩾1 year before, and 2 years after, device setup. Healthcare resource utilization was determined on the basis of the number of all-cause hospitalizations and emergency room visits over 3, 12, and 24 months after positive airway pressure initiation. Results Data from 179,188 patients showed a clear dose–response relationship between daily positive airway pressure usage and healthcare utilization. Minimum device usage required for benefit was 1–3 hours per night. There was a statistically significant decrease in hospitalizations and emergency room visits at all time points (all P s < 0.0001) with increasing positive airway pressure usage. Each additional hour of usage per night decreased hospitalizations and emergency room visits by 5–10% and 5–7%, respectively. Conclusions These data provide compelling evidence for a dose–response relationship between positive airway pressure usage and healthcare utilization, with benefits seen even when usage was as low as 1–2 hours per night.

The Value of Implementing a Digital Approach in the Obstructive Sleep Apnoea Patient Pathway: A Spanish Example

“…It has previously been reported that each additional hour per night of device usage was associated with a 5%–10% reduction in the number of emergency room visits and hospitalisations. 31 In the current study, the number of planned hospital appointments per patient in the digital pathway group was half that in the standard pathway group. This means that the digital approach could reduce the patient burden of travel time to appointments (resulting in a gain in work and/or leisure time).…”

“… 30 Furthermore, a clear dose-response relationship has been reported between hours of positive airway pressure usage for OSA treatment and healthcare utilisation. 31 Therefore, any increase in CPAP usage is likely to have incremental benefits. It has previously been reported that each additional hour per night of device usage was associated with a 5%–10% reduction in the number of emergency room visits and hospitalisations.…”

Mild obstructive sleep apnoea in females:post hocanalysis of the MERGE randomised controlled trial

“…Previous studies have shown that females are able to achieve good long-term compliance to CPAP therapy [ 27 ] and that there is a linear dose response to CPAP usage and positive outcomes, with reductions in healthcare utilisation seen with as little as 1–2 h usage per night [ 28 ], and improved sleepiness starting at as little as 2.5 h [ 29 ], whereas memory and executive function may require at least 6 h per night to see substantial improvements [ 29 – 31 ]. However, this notion is based on data from patients with moderate-to-severe OSA.…”

Actualización sobre la Terapia de Presión Positiva Continua en las Vías Respiratorias como Tratamiento del Síndrome de Apnea del Sueño

“…Finalmente, observaron una reducción temporal de la presión arterial sistólica matutina con CPAP (21). Se observó que, existe una relación dosis-respuesta entre el uso de presión positiva en las vías respiratorias y la utilización de asistencia sanitaria, con beneficios observados incluso cuando el uso fue tan bajo como 1-2 horas por noche (22).…”

“…Con más investigación y la repetición de este estudio en muestras más grandes para determinar la generalidad, la intervención CPAP-SAVER puede proporcionar las bases para el desarrollo final de un protocolo de gestión de la adherencia a la CPAP y la AOS frente a 15 [10][11][12][13][14][15][16][17][18][19]/h, ambos p < 0,001). La cantidad de sueño de ondas lentas (SWS) y de sueño de movimientos oculares rápidos (REM) aumentó significativamente (SWS 20 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] frente a 29 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]%, REM 16 [11][12][13][14][15][16]…”