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Sleep apnea and hospital readmissions: CPAP adherence matters

Non-adherent patients are three times more likely to be readmitted to the hospital within 30 days.

Jeff Lagasse, Associate Editor

A new study of patients with obstructive sleep apnea suggests that non-adherence to continuous positive airway pressure therapy, or CPAP, is tightly linked with an increase in 30-day hospital readmissions. 

The results showed that non-adherent patients were three times more likely to be readmitted to the hospital within 30 days for any cause. They also were twice as likely to be readmitted for cardiovascular reasons; the leading cardiovascular causes for readmission in these patients were atrial fibrillation, myocardial ischemia and congestive heart failure, all of which are connected to untreated sleep apnea.

Many hospitals are trying to drive down their 30-day readmission rates in order to avoid financial penalties. The Centers for Medicare and Medicaid Services effectively withhold reimbursement to hospitals that fare worse than their peers when it comes to keeping patients out of the hospital. According to Loopback Analytics, hospitals were penalized about $108 million more in 2017 than in the previous year for readmissions alone.

Nearly 30 million adults in the U.S. have obstructive sleep apnea, a chronic disease that involves the repeated collapse of the upper airway during sleep. Common warning signs include snoring and excessive daytime sleepiness. CPAP therapy uses mild levels of air pressure provided through a mask to keep the throat open during sleep.

The study involved 345 patients with obstructive sleep apnea who were hospitalized at a VA medical center from Jan. 1, 2007, to Dec. 31, 2015. Ninety-five percent of the participants were men, and 72 percent were white. The 183 adherent patients were an average of 66 years old, and the 162 non-adherent patients weer 62, on average.

Objective CPAP data was analyzed according to the Medicare definition of CPAP adherence, which is CPAP use for four or more hours per night on 70 percent of nights during a consecutive minimum period of 30 days. Results were adjusted for potential confounders such as age, sex, body mass index, living situation, race, comorbidities and medication adherence.

The authors reiterated that 30-day readmissions are touted as the key quality indicator for hospitals and a way to reduce healthcare costs.

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