Positive Airway Pressure Therapy and Health Care Resource Use in Patients With OSA and Comorbid Insomnia

Insomnia and OSA, together known as comorbid insomnia and OSA (COMISA), are highly prevalent sleep disorders, each of which has the potential to impair treatment efficacy for the other.

Is adherence to positive airway pressure (PAP) therapy, the first-line treatment for OSA, associated with reduced health care resource use in patients with COMISA?

We linked de-identified payer-sourced medical claims and objective PAP use data for patients with insomnia and newly diagnosed with OSA. Inverse probability of treatment weighting was used to create covariate-balanced groups of patients who either were adherent, intermediately adherent, or nonadherent to PAP therapy to compare rates of hospitalizations and emergency room (ER) visits. A contextual analysis was conducted among those with OSA without insomnia.

From a sample of 27,071 patients with COMISA (average age, 53.6 years; 53% female), 72% were at least intermediately adherent to PAP over 2 years. During the first year, PAP adherence was associated significantly with fewer ER visits (mean [SD]: adherent, 0.50 [1.39] vs intermediate, 0.59 [1.36] [P < .001]; vs nonadherent, 0.68 [1.74] [P < .001]) and all-cause hospitalizations (mean [SD]: adherent, 0.10 [0.53] vs intermediate, 0.15 [0.60] [P < .001]; vs nonadherent, 0.14 [0.57] [P < .001]). Results were similar in the second year of PAP use. When viewed in the context of patients with OSA without insomnia, patients with COMISA showed lower PAP use and higher rates of resource use both before and after the index date, but showed similar relative reductions in ER visits and hospitalizations with PAP adherence.

These results provide additional evidence from a large, diverse sample to support the treatment of OSA in patients with COMISA and encourage development of COMISA-specific strategies to improve acceptance of PAP therapy.