Impact of High PAP Adherence on Cardiovascular Outcomes Among Medicare Beneficiaries with Obstructive Sleep Apnea, 2006-2015

2018 Strategic Research Grant

Jennifer S. Albrecht, PhD
University of Maryland School of Medicine

Key Project Outcomes

Cardiovascular disease (CVD) is a leading cause of death and disability in the United States and worldwide. Between 40 to 60% of CVD patients suffer from comorbid obstructive sleep apnea (OSA), a common problem in older adults which further impairs cardiac function and worsens CVD outcomes. Evidence suggests that successful treatment of OSA with continuous positive airway pressure (CPAP) can prevent future cardiovascular (CV) events, regardless of pre-existing CVD. However, the beneficial effects of CPAP are strongly related to adherence, making interpretation of many studies difficult. To advance understanding, the objectives of this funded Strategic Research Grant were to evaluate the potential benefits of CPAP on the risk for CV events and increased healthcare utilization (HCU) among Medicare beneficiaries newly diagnosed with OSA. We conducted a study among Medicare beneficiaries aged ≥ 65 years with OSA (2009-2013) and used billing for CPAP devices and supplies to create a monthly CPAP adherence indicator. We examined risk for new CV events (ischemic heart disease, cardiac and peripheral procedures) and stroke associated with higher vs. lower adherence to CPAP over the course of one year. We also examined the impact of CPAP adherence on HCU including hospitalization and emergency department use among Medicare beneficiaries diagnosed with OSA and CVD. Among Medicare beneficiaries diagnosed with OSA between 2009-2013 who initiated CPAP, we observed that increased adherence to CPAP was associated with a 6% decrease in risk for new CV events and a 4% decrease in risk of ischemic stroke. Furthermore, among Medicare beneficiaries with OSA who had also been diagnosed with CVD and relative to those with low CPAP adherence, those with high CPAP adherence experienced a 25% reduction in hospitalizations. Overall, results from this award provide evidence for the beneficial effects of CPAP adherence on reduced risk for CV events, stroke, and inpatient healthcare utilization.

Journal Articles


CPAP Adherence Reduces Cardiovascular Risk Among Older Adults with Obstructive Sleep Apnea


CPAP adherence is associated with reduced risk for stroke among older adult Medicare beneficiaries with obstructive sleep apnea

CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease

Undiagnosed obstructive sleep apnea increases risk of hospitalization among a racially diverse group of older adults with comorbid cardiovascular disease