0780 Continuous Positive Airway Pressure Adherence and the Risk of 30-day Hospital Readmission in Older Adults with Obstructive Sleep Apnea and Cardiovascular Disease

Abstract

Abstract Introduction Obstructive sleep apnea (OSA) negatively impacts outcomes among patients with pre-existing cardiovascular disease (CVD). Evidence suggests treating OSA can prevent additional cardiovascular events and health care utilization, but the benefits of continuous positive airway pressure (CPAP) are strongly related to adherence. We evaluated the effect of adherence to CPAP on 30-day hospital readmissions among Medicare beneficiaries with OSA and pre-existing CVD. Methods We conducted a retrospective study of a 5% sample of Medicare beneficiaries aged ≥ 65 years with pre-existing CVD who were newly diagnosed with OSA, initiated CPAP 2009-2013, maintained continuous Medicare coverage for 24 months post-CPAP initiation, and had at least one hospitalization. Monthly indicators of CPAP adherence (charges for machines, masks, or supplies) were summed over 25 months to create a CPAP adherence variable and then beneficiaries categorized as low, partial, or high adherers (i.e., <4, 4-12 and >12 CPAP charges, respectively).The primary outcome was the risk of 30-day readmission. Bivariate associations were assessed between CPAP adherence status, covariates, and potential confounders. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using logistic regression models, controlling for demographic factors, and pre-existing comorbidities. Statistical significance was assessed at p < 0.05. Results We identified 1,301 beneficiaries meeting study criteria. The mean age was 73±6 years, 87% were White (n=1,137), and 53% were male (n=684). In the 2-year period following CPAP initiation, the overall 30-day readmission rate was 10.2%. Beneficiaries who were readmitted were more likely to be male and with a higher comorbidity burden. In adjusted models and compared to patients with low CPAP use (<4 charges), those with partial use (4-12 charges) and high use (>12 charges) had a lower odds of 30-day readmission (OR = 0.82, 95% CI 0.53-1.23 and OR = 0.41, 95% CI 0.24-0.70). Conclusion In this nationally representative sample of older adults with CVD and comorbid OSA, higher CPAP use was associated with decreased odds of 30-day readmission, highlighting the importance of adherence in mitigating negative outcomes. Support (If Any) This work is supported by an investigator-initiated grant and a diversity supplement from the American Association of Sleep Medicine Foundation (Albrecht, PI).