CPAP Improves Outcomes for Hospitalized Patients With OSA, Cardiovascular Disease

M. Doyinsola Bailey, PhD

While cardiovascular disease and obstructive sleep apnea are comorbid conditions for many, high adherence to continuous positive airway pressure (CPAP) results in much better outcomes for hospitalized patients.

A team, led by M. Doyinsola Bailey, PhD, Graduate Research Assistant at University of Maryland, Baltimore (UMB), evaluated the effect of CPAP adherence on 30-day hospital readmission among Medicare beneficiaries hospitalized with obstructive sleep apnea and cardiovascular disease.

Patients With OSA, Cardiovascular Disease

It is not uncommon for patients hospitalized to have comorbid cardiovascular disease and obstructive sleep apnea. However, OSA is often underdiagnosed and undertreated in this patient population, despite the fact that treatment of the sleep apnea could reduce health care utilization.

“Cardiovascular disease is the number one killer of older adults in the world,” said corresponding author Jennifer Albrecht, who has a doctorate in epidemiology and is an associate professor of epidemiology and public health at the University of Maryland School of Medicine in Baltimore, said in a statement. “Older adults with comorbid cardiovascular disease and obstructive sleep apnea are a vulnerable population at high risk for hospital readmission. Our data show that successful treatment of obstructive sleep apnea can greatly reduce the risk of 30-day hospital readmission.”

While the benefits of continuous positive airway pressure therapy is related directly to adherence, it has not been thoroughly studied in patients hospitalized with cardiovascular disease.

In the retrospective cohort study, the investigators looked at 1301 Medicare beneficiaries aged 65 years and older with pre-existing cardiovascular disease who were diagnosed with obstructive sleep apnea between 2009-2013, initiated CPAP, and were hospitalized.

The investigators defined CPAP adherence as non-adherent, partially adherent, or highly adherent based on the number of machine charges (<4, 4-12, and >12, respectively) over 25 months of follow-up.

The team sought primary outcomes of the 30-day hospital readmission.

The Value of CPAP

The 30-day readmission rate in the study population was 10.2%, but adjusted models suggest those with high adherence to CPAP had lower odds of 30-day readmission compared to patients with low CPAP adherence (OR, 0.41; 95% CI, 0.24-0.70).

High CPAP adherence also resulted in a significant protective effect on the 30-day readmission for beneficiaries with heart failure (OR, 0.50; 95% CI, 0.16-0.79). The same was not found for patients with other cardiovascular diseases.

“In this nationally representative sample of older adults with CVD and comorbid OSA, high CPAP adherence was associated with lower odds of 30-day readmission,” the authors wrote. “These results highlight the importance of screening for and treating OSA among individuals with CVD.”

There are currently nearly 30 million adults in the US with obstructive sleep apnea, 40-60% of which also are diagnosed with cardiovascular disease.

“Obstructive sleep apnea is highly treatable, and treatment improves quality of life,” said Albrecht. “Patients show signs of obstructive sleep apnea, such as snoring, daytime sleepiness, or poor sleep quality, they should talk to their doctor, and doctors should ask about sleep, especially when caring for older adult patients with cardiovascular disease.”

The study, “Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease,” was published online in the Journal of Clinical Sleep Medicine.