Dose-Response Relationship of Sleep Apnea Therapy and Healthcare Use in Patients with Comorbidities

Sleep. 2025 Oct 27:zsaf333. doi: 10.1093/sleep/zsaf333. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has complex interactive relationships with several other conditions. Previous research suggests that consistent adherence to positive airway pressure (PAP) therapy can reduce healthcare resource utilization (HCRU) in comorbid populations. We hypothesized that PAP therapy use would be associated with dose-dependent improvements in HCRU among patients with OSA and comorbid chronic obstructive pulmonary disease (COPD), type 2 diabetes, depression, heart failure, or atrial fibrillation.

METHODS: We analyzed a linked data set of medical/pharmacy claims data and objective PAP usage data for adults with newly diagnosed OSA between Jan 2015 and May 2021. Comorbidities were defined by ≥2 healthcare encounters or ≥ 1 hospitalization with the relevant diagnosis in the year before PAP initiation [index]. HCRU outcomes included all-cause hospitalizations and emergency room (ER) visits over 12 and 24 months post-index.

RESULTS: Among 377 830 patients with OSA (mean age 51.7 years; 57.7% male), 6.6% had COPD, 18.7% type 2 diabetes, 16.5% depression, 4.2% heart failure, and 5.2% atrial fibrillation. Across all comorbidity cohorts, PAP usage was associated with a dose-dependent reduction in HCRU over 12 and 24 months. Risk-adjusted analyses showed HCRU benefits beginning at 2 to<4 hours of average nightly PAP use. Each additional hour of use was associated with a 4.1-6.2% reduction in hospitalizations and ER visits (all analyses p<.0001).

CONCLUSIONS: PAP therapy use is associated with dose-dependent reductions in HCRU among patients with OSA and major comorbidities. These findings may support data-driven reimbursement policies and highlight the value of treating OSA in complex patient populations.

PMID:41143507 | DOI:10.1093/sleep/zsaf333