1184 Positive-Airway Pressure Adherence is Associated with Decreased Healthcare Expenditure: A Pilot Study in Law Enforcement Officers

Abstract Introduction Law enforcement officers (LEOs) are at risk for obstructive sleep apnea (OSA) due to high prevalence of risk factors including obesity, middle age and male gender. OSA leads to high healthcare costs for employed adults. For LEOs, OSA-related daytime sleepiness may also impact job performance in an occupation for which the consequences can be significant. The impact of diagnosis and treatment of OSA with positive airway therapy (PAP) in this population, and an assessment of whether this approach can lower healthcare costs is unknown. Methods This pilot study evaluated a telemedicine-driven program to screen and treat OSA in LEOs. High-risk participants identified by Multivariable Apnea Prediction Index (MVAP) ≥0.6 underwent home sleep testing, and those diagnosed with OSA started PAP with remote monitoring. Epworth sleepiness scale (ESS), quality-of-life (FOSQ) scores, and healthcare expenditures were collected at baseline and tracked after PAP initiation. We conducted descriptive statistics (proportions) for ESS, FOSQ, and used Kruskal-Wallis to assess significance of cost data. Results Out of 192 screened LEOs, 37 were eligible, and 30 enrolled in the study. A total of 29 participants underwent home sleep apnea testing, 23 of them were diagnosed with OSA and prescribed PAP. 22 participants started PAP therapy, and 13 of them maintained PAP compliance over the 24-month period. Mean ESS decreased from 7.8 to 5.0 in 6 months, and FOSQ increased from 3.4 to 3.7 over 18 months (p>0.05). PAP adherence varied, 10% were compliant, 33% moderately compliant, 13% did not use it, and the rest did not report data. Reductions in ESS correlated with the degree of PAP adherence, with greater use associated with a larger reduction in sleepiness. In contrast, increased health expenditures were observed among non-users and partial users (p=0.0433). Conclusion This pilot study demonstrates that consistent PAP use among LEOs with OSA tended to have reduced medical and medication costs within two years of treatment initiation, whereas partial or non-use led to increased healthcare costs. Full PAP adherence may drive meaningful economic benefit, and larger studies should explore additional OSA treatments as well. Support (if any) AASM Foundation Grant: 192-SR-18.