Positive Airway Pressure, Mortality, and Cardiovascular Risk in Older Adults With Sleep Apnea
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Published:2024-09-11
Issue:9
Volume:7
Page:e2432468
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Mazzotti Diego R.12, Waitman Lemuel R.3, Miller Jennifer4, Sundar Krishna M.5, Stewart Nancy H.2, Gozal David6, Song Xing3, , Chandaka Sravani7, Anuforo Kelechi (KayCee)7, Patel Lav7, Budine Daryl7, Hensel Nathan7, Satyakam Siddharth7, Smith Sharla7, Ridenour Dennis7, Jernigan Cheryl7, Early Carol7, Stephens Kyle7, Jurius Kathy7, Sidebottom Abbey7, Rodgers Cassandra7, Zhong Hong7, Raj Vino7, Melendez Victor7, Hare Angie7, Melamed Roman7, Anderson Curtis7, Schouweile Thomas7, Roering Christine7, Payne Philip7, Gupta Snehil7, Newland John7, Lai Albert7, Balls-Berry Joyce7, Parham Janine7, Fritschle Evin7, Cripps Shanelle7, Knowlton Kirk7, Hansen Channing7, Serezlic Erna7, Horne Benjamin7, VanWormer Jeff7, Hase Judith7, Southworth Janet7, Larose Eric7, Davis Mary7, Hoeth Laurel7, Strey Sandy7, Taylor Brad7, Osinski Kris7, Haverty April7, Stoddard Alex7, Cornell Sarah7, Do Phoenix7, Bailey Lucy7, McDonough Beth7, Chrischilles Betsy7, Carnahan Ryan7, Gryzlak Brian7, Ryu Gi-Yung7, Oaklander Katrina7, Bruce Pastor7, McDowell Brad7, Field Jarrod7, Mosa Abu7, Lawson Sasha7, McClay Jim7, Islam Soliman7, Mandhadi Vasanthi7, Kimminau Kim7, Ordway Jeff7, Stephens Bill7, Waitman Russ7, Cassone Deandra7, Niu Xiaofan7, Royse Lisa7, Paka Vyshnavi7, Wilcox Lori7, Greening Janelle7, Geary Carol7, Viswanathan Goutham7, Svoboda Jim7, Campbel Jim7, (Annette) Frances7, Bah Haddy7, Bjorklund Todd7, Barlocker Jackson7, Spuh Josh7, Stark Louisa7, Strong Mike7, Fahina Otolose7, Hess Rachel7, Kean Jacob7, Mumford Sarah7, Huffman Ainsley7, Risenmay Annie7, Ellsmore Olivia7, Persson Lissa7, Torres Kayla7, Stanford Sandi7, Syed Mahanaz7, Schofield Rae7, Zozus Meredith7, Shukwit Brian7, Decaro Matthew7, Heredia Natalia7, Miller Charles7, Robinson Alice7, Bernstam Elmer7, Ashraf Fatima7, Antony Shiby7, Fong Juliet7, Reeder Philip7, Kao Cindy7, Wilkinson Kate7, Greer Tracy7, Cowell Lindsay7
Affiliation:
1. Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City 2. Division of Medical Informatics, Department of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City 3. Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia 4. College of Nursing, University of Nebraska Medical Center, Omaha 5. Department Division of Pulmonary and Critical Care Medicine, Department of Medicine University of Utah, Salt Lake City 6. Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 7. for the Greater Plains Collaborative
Abstract
ImportancePositive airway pressure (PAP) is the first-line treatment for obstructive sleep apnea (OSA), but evidence on its beneficial effect on major adverse cardiovascular events (MACE) and mortality prevention is limited.ObjectiveTo determine whether PAP initiation and utilization are associated with lower mortality and incidence of MACE among older adults with OSA living in the central US.Design, Setting, and ParticipantsThis retrospective clinical cohort study included Medicare beneficiaries with 2 or more distinct OSA claims identified from multistate, statewide, multiyear (2011-2020) Medicare fee-for-service claims data. Individuals were followed up until death or censoring on December 31, 2020. Analyses were performed between December 2021 and December 2023.ExposuresEvidence of PAP initiation and utilization based on PAP claims after OSA diagnosis.Main Outcomes and MeasuresAll-cause mortality and MACE, defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularization. Doubly robust Cox proportional hazards models with inverse probability of treatment weights were used to estimate treatment effect sizes controlling for sociodemographic and clinical factors.ResultsAmong 888 835 beneficiaries with OSA included in the analyses (median [IQR] age, 73 [69-78] years; 390 598 women [43.9%]; 8115 Asian [0.9%], 47 122 Black [5.3%], and 760 324 White [85.5%] participants; median [IQR] follow-up, 3.1 [1.5-5.1] years), those with evidence of PAP initiation (290 015 [32.6%]) had significantly lower all-cause mortality (hazard ratio [HR], 0.53; 95% CI, 0.52-0.54) and MACE incidence risk (HR, 0.90; 95% CI, 0.89-0.91). Higher quartiles (Q) of annual PAP claims were progressively associated with lower mortality (Q2 HR, 0.84; 95% CI, 0.81-0.87; Q3 HR, 0.76; 95% CI, 0.74-0.79; Q4 HR, 0.74; 95% CI, 0.72-0.77) and MACE incidence risk (Q2 HR, 0.92; 95% CI, 0.89-0.95; Q3 HR, 0.89; 95% CI, 0.86-0.91; Q4 HR, 0.87; 95% CI, 0.85-0.90).Conclusions and RelevanceIn this cohort study of Medicare beneficiaries with OSA, PAP utilization was associated with lower all-cause mortality and MACE incidence. Results might inform trials assessing the importance of OSA therapy toward minimizing cardiovascular risk and mortality in older adults.
Publisher
American Medical Association (AMA)
Reference49 articles.
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