Researchers analyzed the outcomes of positive airway pressure therapy for Medicare beneficiaries with obstructive sleep apnea.
In a study observing Medicare beneficiaries with obstructive sleep apnea (OSA), participants receiving positive airway pressure therapy (PAP) experienced lower mortality rates and incidences of major adverse cardiovascular events (MACE). Researchers suggested that results of the study be used for future considerations and trials utilizing OSA therapy to treat cardiovascular diseases (CVD) in older adults.
“OSA is highly prevalent (9%-37% in men and 4%-50% in women), affecting nearly 1 billion people worldwide. OSA becomes more prevalent with age and obesity and is associated with CVD and mortality. The CV risk due to OSA is greater among those with excessive sleepiness, worse nocturnal hypoxemia, and differential heart rate responses to respiratory events,” wrote authors of the study published in JAMA Network Open.1
According to the authors, PAP is the standard of care for treating patients with moderate or severe OSA. In the US alone, 39 million adults suffer from OSA while 33 million of them consistently use a constant positive airway pressure machine, also known as a CPAP machine.2
While both OSA and the utilization of PAP are significantly prevalent worldwide, to researchers’ knowledge, there is a lack of data regarding the use of PAP to treat CV complications and improve all-cause mortality. “Whether long-term PAP therapy prevents CV disease in a clinical population is a critical question that remains unanswered,” they wrote.1
Researchers observed a specified population in order to garner more accurate results among study participants. The population, Medicare beneficiaries in the central US, was chosen because of its representation of a more robust group of older adults who more commonly receive OSA and CVD diagnoses, compared with non-Medicare beneficiaries.
“Although informative, studies on a sample of beneficiaries might not fully represent underserved regions in the US. Thus, the analysis of statewide Medicare claims might provide more generalizable effect estimates in these regions,” wrote the authors.1
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The retrospective clinical cohort study gathered a total of 888,835 beneficiaries (median age, 73 years; 390,598 women [43.9%]; 47,122 Black [5.3%]; median follow-up, 3.1 years) with OSA. All included participants were at least 65 years old with 2 or more distinct insurance claims involving OSA. Claims were identified using Greater Plains Collaborative Reusable Observable Unified Study Environment data across 11 central US states from 2011 to 2020.
Among the entire study population, 32.6% of participants underwent PAP initiation. With just over 290,000 beneficiaries receiving PAP treatment, this specific group among the cohort experienced significantly lower all-cause mortality and risks of MACE. Researchers also mentioned how “higher quartiles of annual PAP claims were progressively associated with lower mortality.”1 The use of PAP for treating MACE and improving mortality in this study was an overall success.
“Findings suggest significant associations between PAP initiation and utilization and lower all-cause mortality and MACE incidence. Associations were also significant for MACE components with consistent effects on [myocardial infarction], [heart failure], and stroke. Higher PAP utilization was progressively associated with lower incidence of outcomes, with consistent results in stratified analysis,” wrote the authors.
Barring further research to improve the efficacy of PAP, results of the study confirm that the common sleep apnea therapy can be a viable option for treatment of both OSA and CVD. Indeed, previous studies have identified a significant association between OSA and various heart diseases, with data showing that sleep apnea increased heart failure risks by 140% and coronary heart disease by 30%.3
While PAP therapy remains the standard of care for patients with OSA, findings that it can also improve CVD outcomes makes PAP an even more sought-after therapy, specifically for Medicare beneficiaries who are more susceptible to underlying CVD conditions and sleep disorders.
“Results support that PAP may have beneficial effects against mortality and CV diseases. This study has the potential to inform future trials assessing the importance of OSA therapy initiation and maintenance toward minimizing adverse health outcomes leading to healthier lives. These results may also help to inform more personalized strategies to improve PAP adherence and efficacy among older adults,” concluded the authors.1
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