Recognition and Treatment of Obstructive Sleep Apnea among Medicare Beneficiaries

2015 Strategic Research Grant

TIFFANY BRALEY, MD
UNIVERSITY OF MICHIGAN

Key Project Outcomes

Through use of large Medicare claims datasets and data from an ongoing survey of Medicare beneficiaries linked to Medicare claims (National Health and Aging Trends study), the overarching purpose of this project was to identify key gaps in obstructive sleep apnea (OSA) recognition and treatment in older Americans, and to assess the impact of OSA treatment on key health outcomes of older individuals in the U.S.

Dr. Braley and colleague findings have shown that although over half of older adults are at risk for OSA, few receive a evaluation with a diagnostic overnight sleep study, suggesting that older adults may be vulnerable to OSA under-recognition. Data from this project have also shed light on disparities in OSA treatment among older Americans, with new evidence suggesting that older women or minorities with neurological conditions may be less likely to receive treatment with positive airway pressure (PAP) for their OSA, compared to their respective male or white counterparts with similar neurological conditions. To this end, Dr. Braley and colleagues’ research has also highlighted the potential impact of OSA treatment on neurocognitive outcomes in older individuals with OSA. In their latest Medicare claims analysis which included 3 years of longitudinal follow up , older individuals who were prescribed PAP for their OSA were less likely to develop Alzheimer’s Disease (AD) and other forms of dementia than those who were not prescribed PAP. This work allows speculation that OSA may serve as a potential therapeutic target to slow or prevent the development of AD – the most frequent cause of dementia in older adults.

Collective work from this AASM-funded project is the first to show, on a national level, that OSA is a common, impactful, and yet underrecognized condition in a high proportion of older Americans. This work also suggests that the potential benefits of PAP therapy in older adults, including reduced dementia risk, may be stymied by significant gaps in treatment, particularly among older women and minorities with neurological conditions. As one of the primary consumers of health services, an improved understanding of which older persons are most likely to benefit from targeted OSA diagnosis and treatment are necessary. This project informs steps to improve the access to high quality OSA care for one of the most rapidly growing demographics in the US.

Journal Articles

SLEEP

Insomnia and Incident Pain in Older Adults: Direct and Mediated Pathways Through Depression and Anxiety

Obstructive sleep apnea treatment and dementia risk in older adults

JOURNAL OF AMERICAN GERIATRIC SOCIETY

Recognition and Diagnosis of Obstructive Sleep Apnea in Older Americans

SLEEP HEALTH

Obstructive sleep apnea treatment disparities among older adults with neurological disorders

SLEEP AND BREATHING

REM obstructive sleep apnea: risk for adverse health outcomes and novel treatments