• Emerson M Wickwire, M Doyinsola Bailey, Virend K Somers, Liesl M Oldstone, Mukta C Srivastava, Abree M Johnson, Steven M Scharf, and Jennifer S Albrecht.
• Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
• J Clin Sleep Med. 2021 Jun 21.

Study ObjectivesTo examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on health care utilization (HCU) among a nationally representative and multimorbid sample of older adults with pre-existing cardiovascular disease and subsequently diagnosed with obstructive sleep apnea (OSA) in the US.MethodsOur data source was a random 5% sample of Medicare administrative claims data. All participants (N=1,921) were age ≥65 years, diagnosed with cardiovascular disease and OSA, and subsequently initiated treatment with CPAP between 2009-2013. Based on the number of CPAP machine charges, individuals were categorized as low, partial, or high adherers (i.e., <4, 4-12 and >12 CPAP charges, respectively). The impact of CPAP adherence status on HCU was assessed across multiple points of service, including outpatient encounters, inpatient stays, emergency department (ED) visits, and prescription fills over 24 months following CPAP initiation.ResultsSignificant differences in demographic and comorbid disease characteristics were observed between low adherers (n=377), partial adherers (n=236) and high adherers (n=1,308). After adjusting for covariates and relative to low adherers, high adherers demonstrated reduced inpatient visits (hazard ratio 0.75; 95% confidence interval 0.57, 0.97).ConclusionsIn this nationally representative sample of older multimorbid Medicare beneficiaries and relative to low adherers, high adherers demonstrated reduced inpatient utilization.© 2021 American Academy of Sleep Medicine.

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