Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA

Singh, Gurtej; Agarwal, Amitesh; Zhang, Wei; Kuo, Yong Fang; Sultana, Rizwana; Sharma, Gulshan

doi:10.1007/s11325-018-1680-0

Cited by 17 publications

(11 citation statements)

References 30 publications

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“…Singh and colleagues studied a Medicare COPD population with coexisting OSA and reported similar rates of comorbidities (e.g., hypertension, type 2 diabetes, and heart failure) and distribution of COPD complexity (a claims-based proxy for disease severity) to our study ( 36 ). Similarly, the distribution of COPD complexity in the current study is consistent with the Medicare COPD and overlap syndrome populations in the study by Starr and colleagues ( 37 ).…”

Section: Discussionsupporting

confidence: 73%

“…To our knowledge, there is only one previous study looking at the impact of initiating PAP therapy in an overlap syndrome population. Using a 5% sample of Medicare fee-for-service beneficiaries with COPD, Singh and colleagues identified 319 patients with comorbid OSA ( 36 ). They found that COPD-related hospitalization rates were lower after PAP initiation (identified by Healthcare Common Procedure Coding System codes), but other ER visits and all-cause hospitalization rates did not differ in users versus nonusers of PAP therapy (although the sample size limits the ability to draw definitive conclusions) ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

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Impact of Positive Airway Pressure Therapy Adherence on Outcomes in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease

Sterling

Pépin

Linde-Zwirble³

et al. 2022

Am J Respir Crit Care Med

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Rationale The co-occurrence of obstructive sleep apnea and chronic obstructive pulmonary disease, termed overlap syndrome, has a poor prognosis. However, data on positive airway pressure (PAP) treatments and their impact on outcomes and costs are lacking. Objectives This retrospective observational study investigated the effects of PAP on health outcomes, resource usage, and costs in patients with overlap syndrome. Methods Deidentified adjudicated claims data for patients with overlap syndrome in the United States were linked to objectively measured PAP user data. Patients were considered adherent to PAP therapy if they met Centers for Medicare and Medicaid Services criteria for eight 90-day timeframes from device setup through 2-year follow-up. Propensity score matching was used to create comparable groups of adherent and nonadherent patients. Healthcare resource usage was based on the number of doctor visits, all-cause emergency room visits, all-cause hospitalizations, and PAP equipment and supplies, and proxy costs were obtained. Measurements and Main Results A total of 6,810 patients were included (mean age, 60.8 yr; 56% female); 2,328 were nonadherent. Compared with the year before therapy, there were significant reductions in the number of emergency room visits, hospitalizations, and severe acute exacerbations during 2 years of PAP therapy in patients who were versus were not adherent (all P < 0.001). This improvement in health status was paralleled by a significant reduction in the associated healthcare costs. Conclusions PAP usage by patients with overlap syndrome was associated with reduced all-cause hospitalizations and emergency room visits, severe acute exacerbations, and healthcare costs.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Impact of Positive Airway Pressure Therapy Adherence on Outcomes in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease

Sterling

Pépin

Linde-Zwirble³

et al. 2022

Am J Respir Crit Care Med

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“…Study Cohort. All patients with COPD were identified as previously reported (9). Exclusion criteria were age 65 years or younger, residence in a nursing facility or enrollment in a health maintenance organization plan, or lack of completed enrollment in Medicare parts A and B for 12 months or longer or until death in Supported by Agency for Healthcare Research and Quality grants R01-HS020642 and R24-HS022134.…”

Section: Methodsmentioning

confidence: 99%

“…Geographic regions were designated by the eight Centers for Medicare and Medicaid Services regions. PSG and PAP therapy were identified as previously described (9).…”

Section: Methodsmentioning

confidence: 99%

Obstructive Sleep Apnea with Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries

et al. 2019

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“…In terms of medical costs, patients with OVS tend to accrue in one study using a Medicaid database, patients with OVS required on average $4,000 more a year in medical expenditures than patients with COPD alone [10]. Treatment of OSA in those with OVS is associated with improvement in mortality [8] and risk of COPD exacerbation [11], while greater average duration of positive airway pressure (PAP) use shows a dose-response relationship toward outcomes [12]. Thus, aggressive diagnosis and treatment of OSA amongst those with COPD appear to be warranted.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of WatchPAT for the Diagnosis of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease

Jen

Orr

et al. 2020

COPD: Journal of Chronic Obstructive Pulmonary Disease

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The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), termed the overlap syndrome (OVS), is associated with adverse outcomes that may be reversed with treatment. However, diagnosis is limited by the apparent need for in-laboratory polysomnography (PSG). WatchPAT is a portable diagnostic device that is validated for the diagnosis of OSA that might represent an attractive tool for the diagnosis of OVS. Subjects with established COPD were recruited from a general population. Subjects underwent PSG and simultaneous recording with WatchPAT. Pulmonary function testing and questionnaires were also performed. A total of 36 subjects were recruited and valid data was obtained on 33 (age 63 ± 7, BMI 28 ± 7, 61% male, FEV 1 56 ± 20% predicted). There was no significant difference in the apnea-hypopnea index (AHI) between PSG and WatchPAT (19 ± 20 versus 20 ± 15 events/h; mean difference 2(-2, 5) events/h; p ¼ 0.381). The AHI was not significantly different in rapid eye movement (REM) and non-rapid eye movement (NREM) determined by PSG versus REM and NREM determined by WatchPAT. WatchPAT slightly overestimated total and REM sleep time, and sleep efficiency. The sensitivity of WatchPAT at an AHI cutoff of !5, !15, and !30 events/h for corresponding PSG AHI cutoffs was 95.8, 92.3, and 88.9, respectively; specificity was 55, 65.0, and 95.8, respectively. WatchPAT is able to determine OSA reliably in patients with COPD. The availability of this additional diagnostic modality may lead to improved detection of OVS, which may in turn lead to improved outcomes for a group of COPD patients at high risk of poor outcomes.

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Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA

Abstract: Initiation of PAP therapy in elderly patients with overlap syndrome is associated with a reduction in hospitalization for COPD-related conditions, but not for all-cause hospitalizations and ER visits.

Cited by 17 publications

References 30 publications

Impact of Positive Airway Pressure Therapy Adherence on Outcomes in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease

Impact of Positive Airway Pressure Therapy Adherence on Outcomes in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease

Obstructive Sleep Apnea with Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries

Accuracy of WatchPAT for the Diagnosis of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease

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