Abstract
Study Objectives
To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults.
Methods
This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses.
Results
In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76).
Conclusions
PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.