Abstract
Introduction
Some studies have shown a benefit while others have shown possible harm in patient outcomes when using positive airway pressure therapy (PAP) for treating sleep disordered breathing (SDB) in patients with heart failure (HF). The goal of this study was to evaluate the number of HF-related and all-cause related hospitalizations in patients with HF and SDB on various forms of PAP therapy versus those on no PAP therapy.
Methods
Administrative claims data from the Truven Health MarketScan Database from 1/1/2005- 10/31/2015 were analyzed. Those included were at least 21 years old, were continuously enrolled for 12 months before and 6 months after their index date (date of PAP prescription), had at least two distinct HF-related claims and were prescribed PAP therapy (n=1,324,414). To model the relationship between each device and hospitalization risk, and to account for the longitudinal and correlated nature of these binary outcome data, generalized estimating equations with binomial family, logit link, and unstructured correlation structure were used.
Results
There were a total of 12,538 patients on Bilevel-PAP, 2,700 patients on bilevel-PAP with backup rate, and 57,405 patients on CPAP, and 73,353 patients with HF and comorbid sleep apnea who were not on any treatment. The reduction in HF-related hospitalization for patients with HF and comorbid SDB treated with bilevel-PAP therapy (0.28; 95% CI 0.26, 0.31) was greater than that in patients receiving CPAP (OR 0.46 95% CI 0.43, 0.49), bilevel PAP with back-up rate (0.39; 95% CI 0.32, 0.49), or no PAP treatment (OR 0.54; 95%CI 0.50, 0.57)(P<0.01). Similar trend was observed for all-cause related hospitalizations. All results were adjusted for propensity score and other relevant confounders.
Conclusion
In claims-based analysis of patients with HF and comorbid SDB, bilevel PAP treatment was associated with reduced hospitalizations when compared to CPAP therapy or no PAP treatment.
Support
Phillips Respironics
Residual sleep-disordered breathing during autotitrating continuous positive airway pressure therapy
