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

Kimberly L Sterling; Peter A Cistulli; Walter Linde-Zwirble; Anita Malik; Adam V Benjafield; Atul Malhotra; Kate V Cole; Hussein Emami; Caleb Woodford; Suyog More; Jeff P Armitstead; Carlos M Nunez; Sirimon Reutrakul; Jean-Louis Pépin; medXcloud Group

doi:10.5664/jcsm.10388

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

J Clin Sleep Med. 2023 Mar 1;19(3):563-571. doi: 10.5664/jcsm.10388.

Authors

Affiliations

¹ ResMed Science Center, San Diego, California.
² Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁴ Trexin Consulting, Chicago, Illinois.
⁵ ResMed Science Center, Sydney, New South Wales, Australia.
⁶ University of California San Diego, La Jolla, California.
⁷ ResMed Science Center, Halifax, Nova Scotia, Canada.
⁸ University of Illinois at Chicago, Chicago, Illinois.
⁹ Institut National de la Santé et de la Recherche Médicale (INSERM) U 1300, HP2 Laboratory (Hypoxia: Pathophysiology), Grenoble Alpes University, Grenoble, France.

Abstract

Study objectives: There is a complex interplay between obstructive sleep apnea (OSA) and type 2 diabetes. There are minimal data regarding the effects of treating OSA with positive airway pressure (PAP) therapy on outcomes and health care resource utilization (HCRU) in patients with OSA and type 2 diabetes. We investigated the impact of PAP adherence on HCRU and costs in this population.

Methods: A retrospective analysis was conducted with a cohort of OSA patient from a US administrative claims dataset linked to objective device data (AirView, ResMed Corp., San Diego, California). Propensity score matching was used to control for potential imbalance in baseline covariates between PAP-adherent and -nonadherent patients. Newly diagnosed patients with OSA aged ≥ 18 years with type 2 diabetes were included. PAP adherence was defined as meeting Centers for Medicare and Medicaid Services compliance criteria in all 8 90-day periods over 2 years. HCRU was based on the number of all-cause doctor visits, emergency room visits, inpatient hospitalizations, and PAP equipment and supplies.

Results: In years 1 and 2 of PAP therapy, HCRU was significantly lower in adherent vs nonadherent patients (number/patient for emergency room visits 0.68 ± 1.47 vs 0.99 ± 1.91 [year 1], 0.69 ± 1.43 vs 0.95 ± 1.89 [year 2]; for hospitalizations 0.16 ± 0.58 vs 0.22 ± 0.62 [year 1], 0.15 ± 0.51 vs 0.21 ± 0.74 [year 2]; all P < .001). Changes in estimated total 24-month payments were higher for nonadherent patients ($2,282, 95% confidence interval: $1,368, $3,205).

Conclusions: Consistent use of PAP therapy over 2 years was associated with decreased HCRU in patients with OSA and type 2 diabetes, strongly suggesting a role for screening and treating OSA in type 2 diabetes.

Citation: Sterling KL, Cistulli PA, Linde-Zwirble W, et al. 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. J Clin Sleep Med. 2023;19(3):563-571.

Keywords: adherence; diabetes; hospitalization; obstructive sleep apnea; positive airway pressure; resource utilization.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Continuous Positive Airway Pressure
Diabetes Mellitus, Type 2*
Humans
Inpatients
Medicare
Patient Compliance
Retrospective Studies
Sleep Apnea, Obstructive* / therapy
United States

Abstract

Publication types

MeSH terms

Grants and funding