Effects of adaptive servoventilation therapy for central sleep apnea on health care utilization and mortality: A population-based study

Meghna Mansukhani, Bhanu Prakash Kolla, James M Naessens, Peter C. Gay, Timothy Ian Morgenthaler

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Objectives: Adaptive servoventilation (ASV) is the suggested treatment for many forms of central sleep apnea (CSA). We aimed to evaluate the impact of treating CSA with ASV on health care utilization. Methods: In this population-based study using the Rochester Epidemiology Project database, we identified patients over a 9-year period who were diagnosed with CSA (n = 1,237), commenced ASV therapy, and had ≥ 1 month of clinical data before and after ASV initiation. The rates of hospitalizations, emergency department visits (EDV), outpatient visits (OPV) and medications prescribed per year (mean ± standard deviation) in the 2 years pre-ASV and post-ASV initiation were compared. Results: We found 309 patients (68.0 ± 14.6 years, 80.3% male, apnea-hypopnea index 41.6 ± 26.5 events/h, 78% with cardiovascular comorbidities, 34% with heart failure) who met inclusion criteria; 65% used ASV ≥ 4 h/night on ≥ 70% nights in their first month. The overall 2-year mortality rate was 9.4% and CSA secondary to cardiac cause was a significant risk factor for mortality (hazard ratio 1.81, 95% CI 1.09–3.01, P = .02). Comparing pre-ASV and post-ASV initiation, there was no change in the rate of hospitalization (0.72 ± 1.63 versus 0.79 ± 1.44, P = .46), EDV (1.19 ± 2.18 versus 1.26 ± 2.08, P = .54), OPV (31.59 ± 112.42 versus 13.60 ± 17.36, P = .22), or number of prescribed medications (6.68 ± 2.0 versus 5.31 ± 5.86, P = .06). No differences in these outcomes emerged after accounting for adherence to ASV, CSA subtype and comorbidities via multiple regression analysis (all P > .05). Conclusions: Our cohort of patients with CSA was quite ill and the use of ASV was not associated with a change in health care utilization.

Original languageEnglish (US)
Pages (from-to)119-128
Number of pages10
JournalJournal of Clinical Sleep Medicine
Volume15
Issue number1
DOIs
StatePublished - Jan 15 2019

Fingerprint

Patient Acceptance of Health Care
Central Sleep Apnea
Mortality
Population
Hospital Emergency Service
Comorbidity
Hospitalization
Outpatients
Therapeutics
Apnea
Epidemiology
Heart Failure
Regression Analysis
Databases

Keywords

  • Automatic servoventilation
  • Complex sleep apnea
  • Emergency room
  • Hospitalization
  • Mortality
  • Outpatient visits
  • Treatment-emergent central sleep apnea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

@article{3c8835fd305c47c1a3410fbe7c100c14,
title = "Effects of adaptive servoventilation therapy for central sleep apnea on health care utilization and mortality: A population-based study",
abstract = "Study Objectives: Adaptive servoventilation (ASV) is the suggested treatment for many forms of central sleep apnea (CSA). We aimed to evaluate the impact of treating CSA with ASV on health care utilization. Methods: In this population-based study using the Rochester Epidemiology Project database, we identified patients over a 9-year period who were diagnosed with CSA (n = 1,237), commenced ASV therapy, and had ≥ 1 month of clinical data before and after ASV initiation. The rates of hospitalizations, emergency department visits (EDV), outpatient visits (OPV) and medications prescribed per year (mean ± standard deviation) in the 2 years pre-ASV and post-ASV initiation were compared. Results: We found 309 patients (68.0 ± 14.6 years, 80.3{\%} male, apnea-hypopnea index 41.6 ± 26.5 events/h, 78{\%} with cardiovascular comorbidities, 34{\%} with heart failure) who met inclusion criteria; 65{\%} used ASV ≥ 4 h/night on ≥ 70{\%} nights in their first month. The overall 2-year mortality rate was 9.4{\%} and CSA secondary to cardiac cause was a significant risk factor for mortality (hazard ratio 1.81, 95{\%} CI 1.09–3.01, P = .02). Comparing pre-ASV and post-ASV initiation, there was no change in the rate of hospitalization (0.72 ± 1.63 versus 0.79 ± 1.44, P = .46), EDV (1.19 ± 2.18 versus 1.26 ± 2.08, P = .54), OPV (31.59 ± 112.42 versus 13.60 ± 17.36, P = .22), or number of prescribed medications (6.68 ± 2.0 versus 5.31 ± 5.86, P = .06). No differences in these outcomes emerged after accounting for adherence to ASV, CSA subtype and comorbidities via multiple regression analysis (all P > .05). Conclusions: Our cohort of patients with CSA was quite ill and the use of ASV was not associated with a change in health care utilization.",
keywords = "Automatic servoventilation, Complex sleep apnea, Emergency room, Hospitalization, Mortality, Outpatient visits, Treatment-emergent central sleep apnea",
author = "Meghna Mansukhani and Kolla, {Bhanu Prakash} and Naessens, {James M} and Gay, {Peter C.} and Morgenthaler, {Timothy Ian}",
year = "2019",
month = "1",
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doi = "10.5664/jcsm.7584",
language = "English (US)",
volume = "15",
pages = "119--128",
journal = "Journal of Clinical Sleep Medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
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TY - JOUR

T1 - Effects of adaptive servoventilation therapy for central sleep apnea on health care utilization and mortality

T2 - A population-based study

AU - Mansukhani, Meghna

AU - Kolla, Bhanu Prakash

AU - Naessens, James M

AU - Gay, Peter C.

AU - Morgenthaler, Timothy Ian

PY - 2019/1/15

Y1 - 2019/1/15

N2 - Study Objectives: Adaptive servoventilation (ASV) is the suggested treatment for many forms of central sleep apnea (CSA). We aimed to evaluate the impact of treating CSA with ASV on health care utilization. Methods: In this population-based study using the Rochester Epidemiology Project database, we identified patients over a 9-year period who were diagnosed with CSA (n = 1,237), commenced ASV therapy, and had ≥ 1 month of clinical data before and after ASV initiation. The rates of hospitalizations, emergency department visits (EDV), outpatient visits (OPV) and medications prescribed per year (mean ± standard deviation) in the 2 years pre-ASV and post-ASV initiation were compared. Results: We found 309 patients (68.0 ± 14.6 years, 80.3% male, apnea-hypopnea index 41.6 ± 26.5 events/h, 78% with cardiovascular comorbidities, 34% with heart failure) who met inclusion criteria; 65% used ASV ≥ 4 h/night on ≥ 70% nights in their first month. The overall 2-year mortality rate was 9.4% and CSA secondary to cardiac cause was a significant risk factor for mortality (hazard ratio 1.81, 95% CI 1.09–3.01, P = .02). Comparing pre-ASV and post-ASV initiation, there was no change in the rate of hospitalization (0.72 ± 1.63 versus 0.79 ± 1.44, P = .46), EDV (1.19 ± 2.18 versus 1.26 ± 2.08, P = .54), OPV (31.59 ± 112.42 versus 13.60 ± 17.36, P = .22), or number of prescribed medications (6.68 ± 2.0 versus 5.31 ± 5.86, P = .06). No differences in these outcomes emerged after accounting for adherence to ASV, CSA subtype and comorbidities via multiple regression analysis (all P > .05). Conclusions: Our cohort of patients with CSA was quite ill and the use of ASV was not associated with a change in health care utilization.

AB - Study Objectives: Adaptive servoventilation (ASV) is the suggested treatment for many forms of central sleep apnea (CSA). We aimed to evaluate the impact of treating CSA with ASV on health care utilization. Methods: In this population-based study using the Rochester Epidemiology Project database, we identified patients over a 9-year period who were diagnosed with CSA (n = 1,237), commenced ASV therapy, and had ≥ 1 month of clinical data before and after ASV initiation. The rates of hospitalizations, emergency department visits (EDV), outpatient visits (OPV) and medications prescribed per year (mean ± standard deviation) in the 2 years pre-ASV and post-ASV initiation were compared. Results: We found 309 patients (68.0 ± 14.6 years, 80.3% male, apnea-hypopnea index 41.6 ± 26.5 events/h, 78% with cardiovascular comorbidities, 34% with heart failure) who met inclusion criteria; 65% used ASV ≥ 4 h/night on ≥ 70% nights in their first month. The overall 2-year mortality rate was 9.4% and CSA secondary to cardiac cause was a significant risk factor for mortality (hazard ratio 1.81, 95% CI 1.09–3.01, P = .02). Comparing pre-ASV and post-ASV initiation, there was no change in the rate of hospitalization (0.72 ± 1.63 versus 0.79 ± 1.44, P = .46), EDV (1.19 ± 2.18 versus 1.26 ± 2.08, P = .54), OPV (31.59 ± 112.42 versus 13.60 ± 17.36, P = .22), or number of prescribed medications (6.68 ± 2.0 versus 5.31 ± 5.86, P = .06). No differences in these outcomes emerged after accounting for adherence to ASV, CSA subtype and comorbidities via multiple regression analysis (all P > .05). Conclusions: Our cohort of patients with CSA was quite ill and the use of ASV was not associated with a change in health care utilization.

KW - Automatic servoventilation

KW - Complex sleep apnea

KW - Emergency room

KW - Hospitalization

KW - Mortality

KW - Outpatient visits

KW - Treatment-emergent central sleep apnea

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DO - 10.5664/jcsm.7584

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