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Does Providing Positive Airway Pressure for Sleep Apnea Change Health Care Utilization?

Derose, Stephen F., MD, MSHS*; Zhou, Hui, PhD*; Huang, Brian Z., MS*; Manthena, Prasanth, MD; Hwang, Dennis, MD; Shi, Jiaxiao M., PhD*

doi: 10.1097/MLR.0000000000000963
Original Article

Background: Sleep apnea is underdiagnosed and thus undertreated. If therapy for sleep apnea results in reduced health care utilization in an entire treated population, then decision-makers will have key information for allocating limited health care resources.

Objectives: To determine whether positive airway pressure (PAP) for sleep apnea was associated with reduced health care utilization in an entire treated population.

Research Design: This was a retrospective cohort; propensity score-matched cases and noncases; pre-post analyses of individual subject utilization.

Subjects: Electronic health records were used to identify adult subjects diagnosed with sleep apnea and dispensed PAP therapy (cases) and those without either diagnosed sleep apnea or dispensed PAP therapy (noncases).

Measures: Acute care hospital days and dispensed medication days supply were compared in cases and noncases. Negative binomial regression was used to model utilization for up to 5 years before and 7 years after PAP dispensation (cases) or a random date (noncases). The association of PAP with changing annual utilization was estimated.

Results: There were 13,271 cases and 13,271 matched noncases from 2008 to 2012 for analyses. Trends in the annual rate of acute care utilization were no different between cases and noncases (rate ratio, 0.98, P=0.543). Trends in the annual rate of medication utilization were no different between cases and noncases (rate ratio, 1.008, P=0.112).

Conclusions: PAP dispensation for sleep apnea did not appear to reduce the rate of acute care and medication utilization over several years of follow-up in a large integrated health care system.

*Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena

Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles

Fontana Medical Center, Kaiser Permanente Southern California, Fontana, CA

Supported by a grant from the ResMed Foundation. The ResMed Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the ResMed Foundation.

Presented at the American Professional Sleep Societies SLEEP Meeting, June 2017, Boston, MA.

The authors declare no conflict of interest.

Reprints: Stephen F. Derose, MD, MSHS, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA 91101. E-mail: stephen.f.derose@kp.org.

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