Abstract
Introduction
Sleep apnea is common in patients with heart failure (HF) and can be treated with positive airway pressure (PAP) therapy. In patients with both HF and sleep apnea, whether treatment of PAP therapy is associated with reduction in hospitalization or mortality is unclear.
Methods
We used 5% Medicare limited-dataset (LDS) from 2013-2015 to perform a retrospective study of hospitalizations and mortality in HF patients with sleep apnea who received or did not receive PAP therapy over an 18-month time period. All-cause mortality during post-treatment period, any and HF-related hospitalizations in baseline, pre-treatment and post-treatment periods were measured and compared. Propensity score matching, generalized estimating equations (GEE) model for repeated measures analysis and COX-survival analysis adjusted by multiple covariates were used for longitudinal comparisons and mortality.
Results
We have identified 281,161 patients with at least two distinct HF onsets and 62,800 of them had sleep apnea diagnosis (22%). Of these patients, 5,540 of them had initiated their PAP therapy while 12,129 of them only had their sleep apnea diagnosis during the selection time frame from Jan 1st, 2014 to June 30th, 2015 without PAP treatment (control group). After adjusting for various confounders and propensity score matching, bilevel PAP was strongly associated with lower hospitalization and HF-associated hospitalization (Bilevel-PAP vs. Control: Any hospitalization, OR=0.62, 95%CI=0.53-0.74, p<0.0001; HF-associated hospitalization, OR=0.65, 95%CI=0.55-0.78, p<0.0001). Cox proportional hazards survival analysis revealed that all of the PAP-treated groups had a better 6-month survival after treatment initiation when compared to controls (any PAP therapy vs. Control: HR=0.32, 95%CI=0.28-0.37, p<0.0001).
Conclusion
In a retrospective analysis, PAP therapy was associated with lower 6-month all-cause mortality among Medicare beneficiaries with HF and sleep apnea. Bilevel-PAP therapy was consistently associated with significant reduction in hospitalization among these patients. Our observational findings warrant confirmation by future prospective intervention trials.
Support
NIH (HL126140; MD011600; HL138377; HL140144; IPA-014264-00001), PCORI (PPRND-1507-31666; PCS-1504-30430), American Academy of Sleep Medicine Foundation (169-SR-17), and Philips Healthcare/ Philips-Respironics Inc.
Readmission Risk Trajectories for Patients With Heart Failure Using a Dynamic Prediction Approach: Retrospective Study
