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 Dr. Doyinsola Bailey, PhD, a graduate research assistant at the University of Maryland, Baltimore (UMB), assessed the effect of CPAP compliance on 30-day hospital readmission in Medicare beneficiaries hospitalized with obstructive sleep apnea and cardiovascular disease.
Patients with OSA, cardiovascular disease
It is not uncommon for hospitalized patients to have comorbid cardiovascular disease and obstructive sleep apnea. However, OSAS is often underdiagnosed and undertreated in this patient population, despite the fact that treating sleep apnea might reduce healthcare utilization.
“Cardiovascular disease is the number one cause of death among older adults worldwide,” said corresponding author Jennifer Albrecht, who holds a doctorate in epidemiology and is an associate professor of epidemiology and public health at the Faculty of medicine from the University of Maryland in Baltimore. in a report. “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 significantly reduce the risk readmission to hospital within 30 days.
Although the benefits of continuous positive airway pressure therapy are directly related to compliance, it has not been extensively studied in patients hospitalized with cardiovascular disease.
In the retrospective cohort study, investigators looked at 1,301 Medicare beneficiaries aged 65 and older with pre-existing cardiovascular disease who were diagnosed with obstructive sleep apnea between 2009 and 2013, started CPAP and were hospitalized.
Investigators defined CPAP adherence as non-adherent, partially adherent, or highly adherent based on the number of machine loads (<4, 4-12 et >12, respectively) over 25 months of follow-up.
The team looked for the main outcomes of hospital readmission within 30 days.
The value of CPAP
The 30-day readmission rate in the study population was 10.2%, but the adjusted models suggest that patients with high CPAP adherence had a lower probability of 30-day readmission compared to patients with poor adherence to CPAP (OR, 0.41; 95% CI, 0.24-0.70).
High CPAP compliance also resulted in a significant protective effect on 30-day readmission for recipients 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 a lower likelihood of 30-day readmission,” the authors wrote. “These findings underscore the importance of screening for and treating OSA in people with cardiovascular disease.”
There are currently nearly 30 million adults in the United States with obstructive sleep apnea, 40-60% of whom are also diagnosed with cardiovascular disease.
“Obstructive sleep apnea is highly treatable, and treatment improves quality of life,” Albrecht said. “Patients have signs of obstructive sleep apnea, such as snoring, daytime sleepiness, or poor sleep quality, they should tell their doctor, and doctors should ask about sleep, especially when taking care elderly patients with cardiovascular disease.
The study, “Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission in older adults with obstructive sleep apnea and comorbid cardiovascular disease,” has been published. online in the Journal of Clinical Sleep Medicine.