作者
Diego R. Mazzotti,Michele Vitacca,Jennifer N. Miller,Krishna M. Sundar,Nancy H. Stewart,Leila Kheirandish‐Gozal,Xing Song,Sravani Chandaka,Kelechi Anuforo,Lav P. Patel,Daryl Budine,Nina Hensel,Siddharth Satyakam,Sharla Smith,Dennis Ridenour,Cheryl Jernigan,Caitlin R. Rausch,Kyle Stephens,Kathy Jurius,Abbey Sidebottom,Christopher T. Rodgers,Hong Zhong,Venkatachalum B. Raj,Victor Meléndez,Alexander J. Hare,Roman Melamed,Curtis A. Anderson,Thomas Schouweile,Christine Roering,Philip Payne,Snehil Gupta,John Newland,Albert M. Lai,Joyce E. Balls‐Berry,Janine Parham,Evin Fritschle,Shanelle T. Cripps,Kirk U. Knowlton,Channing Hansen,Erna Serezlic,Benjamin D. Horne,Jeff VanWormer,Jan C. Hase,J. Southworth,Éric Larose,Mary F. Davis,Laurel Hoeth,Sandy Strey,Bradley Taylor,Kris Osinski,April Haverty,Alexander J. Stoddard,Sarah Cornell,Phoenix Do,Lucy Bailey,Barbara McDonough,Betsy Chrischilles,Ryan M. Carnahan,Brian Gryzlak,Gwanghui Ryu,Katrina Oaklander,Patricia D. Bruce,Bradley D. McDowell,Jane Field,Abu Saleh Mohammad Mosa,S. Lawson,James C. McClay,Soliman Islam,Vasanthi Mandhadi,Kim S. Kimminau,Jeff Ordway,Byron F. Stephens,Russ Waitman,Deandra Cassone,Xiaoli Niu,Lisa Royse,Vyshnavi Paka,George L. Wilcox,Janelle Greening,Carol Geary,Girish Viswanathan,Jakub Svoboda,Jim Campbel,V Frances,Haddy Bah,Tomas Björklund,Jackson Barlocker,Josh Spuh,Louisa A. Stark,Mike Strong,Otolose Fahina,Rachel Hess,Jacob Kean,Sarah Mumford,Ainsley E. Huffman,Annie Risenmay,Olivia Ellsmore,Lennart Persson,Kayla Torres,Sophia Stanford
摘要
Importance Positive airway pressure (PAP) is the first-line treatment for obstructive sleep apnea (OSA), but evidence on its beneficial effect on major adverse cardiovascular events (MACE) and mortality prevention is limited. Objective To determine whether PAP initiation and utilization are associated with lower mortality and incidence of MACE among older adults with OSA living in the central US. Design, Setting, and Participants This retrospective clinical cohort study included Medicare beneficiaries with 2 or more distinct OSA claims identified from multistate, statewide, multiyear (2011-2020) Medicare fee-for-service claims data. Individuals were followed up until death or censoring on December 31, 2020. Analyses were performed between December 2021 and December 2023. Exposures Evidence of PAP initiation and utilization based on PAP claims after OSA diagnosis. Main Outcomes and Measures All-cause mortality and MACE, defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularization. Doubly robust Cox proportional hazards models with inverse probability of treatment weights were used to estimate treatment effect sizes controlling for sociodemographic and clinical factors. Results Among 888 835 beneficiaries with OSA included in the analyses (median [IQR] age, 73 [69-78] years; 390 598 women [43.9%]; 8115 Asian [0.9%], 47 122 Black [5.3%], and 760 324 White [85.5%] participants; median [IQR] follow-up, 3.1 [1.5-5.1] years), those with evidence of PAP initiation (290 015 [32.6%]) had significantly lower all-cause mortality (hazard ratio [HR], 0.53; 95% CI, 0.52-0.54) and MACE incidence risk (HR, 0.90; 95% CI, 0.89-0.91). Higher quartiles (Q) of annual PAP claims were progressively associated with lower mortality (Q2 HR, 0.84; 95% CI, 0.81-0.87; Q3 HR, 0.76; 95% CI, 0.74-0.79; Q4 HR, 0.74; 95% CI, 0.72-0.77) and MACE incidence risk (Q2 HR, 0.92; 95% CI, 0.89-0.95; Q3 HR, 0.89; 95% CI, 0.86-0.91; Q4 HR, 0.87; 95% CI, 0.85-0.90). Conclusions and Relevance In this cohort study of Medicare beneficiaries with OSA, PAP utilization was associated with lower all-cause mortality and MACE incidence. Results might inform trials assessing the importance of OSA therapy toward minimizing cardiovascular risk and mortality in older adults.