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Impact of Positive Airway Pressure Therapy on Health Care Resource Use in Patients With OSA and Coronary Artery

Peter A Cistulli1, Anita S Malik2, Adam V Benjafield3

  • 1Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.

Chest
|October 11, 2025
PubMed

Insights

Adhering to positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) in coronary artery disease (CAD) patients significantly reduces healthcare costs. Even minimal nightly use shows benefits, highlighting the importance of OSA treatment.

Area of Science:

  • Cardiology
  • Pulmonology
  • Health Services Research

Background:

  • Obstructive sleep apnea (OSA) is a known risk factor for coronary artery disease (CAD).
  • The impact of positive airway pressure (PAP) therapy adherence on healthcare resource utilization (HCRU) in patients with both CAD and OSA is not well understood.

Purpose of the Study:

  • To investigate whether adherence to PAP therapy is associated with reduced HCRU in patients diagnosed with both CAD and OSA.
  • To quantify the relationship between PAP adherence and healthcare utilization outcomes.

Main Methods:

  • Retrospective analysis of administrative claims linked with objective PAP usage data.
  • Included adults (≥18 years) with CAD and newly diagnosed OSA.
  • Two-year adherence defined by 90-day intervals; inverse probability of treatment weighting used to assess ER visits and hospitalizations.

Main Results:

  • 32,911 patients included; adherent patients had significantly fewer ER visits (-24% to -26%) and hospitalizations (-35% to -39%) compared to nonadherent patients.
  • Intermediate adherence correlated with HCRU between adherent and nonadherent groups.
  • Minimum nightly PAP use <3 hours/night yielded significant HCRU benefits; each additional hour reduced HCRU by 4.7%-5.9%.

Conclusions:

  • PAP therapy adherence is linked to lower HCRU in real-world patients with CAD and newly diagnosed OSA.
  • These findings underscore the clinical and economic importance of diagnosing and treating OSA in patients with CAD.
Abstract

Keywords:
OSAadherencecoronary artery diseasehealth care resource usepositive airway pressure

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