Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

Abstract

Background: Obesity is associated with obstructive sleep apnoea (OSA) and cardiovascular risk. Positive airway pressure (PAP) is the first line treatment for OSA, but evidence on its beneficial effect on major adverse cardiovascular events (MACE) prevention is limited. Using claims data, the effects of PAP on mortality and incidence of MACE among Medicare beneficiaries with OSA were examined. Methods: A cohort of beneficiaries (>65 years) with ≥5 years of consecutive enrolment to Medicare and ≥2 distinct OSA claims was defined from multi-state, state-wide, multi-year (2011-2017) Medicare fee-for-service claims data. Evidence of PAP initiation and utilisation was based on PAP claims after OSA diagnosis. MACE was defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularisation. Doubly robust Cox proportional hazards models with inverse probability of treatment weights estimated treatment effects controlling for sociodemographic and clinical factors. Results: Among 225,132 beneficiaries with OSA (median age 74 years; 45.3% women; median follow-up 3 years), those with evidence of PAP initiation (50.1%) had significantly lower all-cause mortality (HR [95%CI]: 0.57 [0.56-0.59]) and MACE incidence risk (0.90 [0.88-0.92]). Higher quartiles of annual PAP claims were progressively associated with lower mortality (Q2: 0.80 [0.75-0.86], Q3: 0.68 [0.64-0.72], Q4: 0.65 [0.61-0.70]) and MACE incidence risk (Q2: 0.91 [0.86-0.97], Q3: 0.87 [0.82-0.91], Q4: 0.85 [0.80-0.90]). Conclusion: PAP utilisation was associated with lower all-cause mortality and MACE incidence among Medicare beneficiaries with OSA. Results might inform trials assessing the importance of OSA therapy towards minimising cardiovascular risk and mortality in older adults.