0999 Effect of Positive Airway Pressure Therapy on Healthcare Resource Utilization in Patients with Comorbid Obstructive Sleep Apnea and Hypertension

Abstract Introduction Obstructive sleep apnea (OSA) and hypertension frequently coexist with some estimates indicating that > 50% of those with OSA are also affected by hypertension. Positive airway pressure (PAP) therapy has been associated with modest improvements in blood pressure. This analysis investigated the association between adherence to PAP therapy with healthcare resource utilization (HCRU) in newly diagnosed OSA patients with comorbid hypertension. Methods This retrospective cohort study analyzed administrative claims from 2014 to 2023, linked with objective PAP therapy device usage data. Adults (≥18 years) with hypertension (based on ICD-9/10 codes) and newly diagnosed OSA who initiated PAP therapy were included. PAP therapy adherence was defined by the number of 90-day quarters in which a patient met CMS compliance criteria (≥4 hours/night on ≥70% of nights in a 30-day period) over 1 year: adherent (4 quarters), intermediately adherent (1-3) quarters, and non-adherent (0 quarters). HCRU in the first year of PAP use was compared across adherence groups, after applying inverse probability of treatment weighting (IPTW) to balance groups on baseline characteristics. Results Among 283,938 OSA PAP-treated patients (44% female, mean age: 55 years), 67% met initial 90-day CMS compliance. Increasing adherence was associated with being male, older, commercially insured, and with lower comorbidity burden. Over 1 year, 72% were defined as at least intermediately adherent. After IPTW adjustment, adherent patients had significantly lower per-person rates of all-cause ER visits (0.56 vs. intermediately adherent: 0.64, p< 0.001; vs. non-adherent: 0.72, p< 0.001) and all-cause hospitalizations (0.13 vs. intermediately adherent: 0.18, p< 0.001; vs. non-adherent: 0.19, p< 0.001). There was a 23% reduction in the risk of any cardiovascular-related HCRU event (cardiovascular-related ER visit or hospitalization) for adherent patients, relative to non-adherent patients (RR: 0.77, 95% CI: 0.74-0.81). Hospitalization and ER visit costs were also significantly lower for adherent compared to intermediately or non-adherent patients. Conclusion In real-world patients with OSA and comorbid hypertension, greater PAP adherence was associated with significantly lower healthcare utilization and costs. Emphasis on screening, diagnosing and treating OSA (including patient adherence support) in patients with hypertension may lead to better outcomes in this population. Support (if any) Resmed