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Sleep apnea treatment associated with lower healthcare costs

PAP adherence also was associated with a significantly lower number of emergency department visits and inpatient stays.

Jeff Lagasse, Associate Editor

Treating patients with moderate or severe obstructive sleep apnea with positive airway pressure therapy is associated with reduced acute care visits and healthcare expenditures, according to a recent study published in the Journal of Clinical Sleep Medicine.

Every one-hour increase in PAP usage per night was associated with an 8% decrease in inpatient visits and a 4% decrease in overall acute care visits.

PAP adherence also was associated with a significantly lower number of emergency department visits and inpatient stays, and increasing PAP usage was associated with a lower likelihood of having positive costs from these visits. Among patients with emergency department costs, PAP adherence was associated with 27% lower costs.

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While the authors expected that treatment for moderate or severe sleep apnea would improve health, the rapid rate at which PAP treatment can have an impact was surprising. They cited older research detailing how many patients often did not adhere to PAP therapy, but suggested adherence could be improved through education and support.


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. PAP therapy uses mild levels of air pressure, provided through a mask, to keep the throat open during the night.

The authors conducted their retrospective cohort study of adult patients who initiated PAP therapy after a diagnosis of moderate or severe sleep apnea at a large integrated health system between 2014-2016. The study consisted of 1,098 patients who had at least 18 months of available data after PAP therapy was initiated. Treatment adherence was defined as using PAP more than four hours per night for at least 70 percent of the nights studied.

Results show that 60% of the study population was adherent to PAP therapy, and the overall average percentage of nights with PAP usage of more than four hours was nearly 70%. The average use on nights when PAP was used was 6.4 hours per night, and the average use on all nights was 5.3 hours.


Starting August 1, UnitedHealthcare began covering a specific therapy for obstructive sleep apnea, a medical implant developed by Inspire Medical Systems.

The policy considers the device to be medically necessary for moderate to severe cases, especially when certain criteria is met, such as a patient previously attempting to undergo PAP therapy.
The hypoglossal nerve neurostimulation device, which was approved by the FDA in 2014, is a small implanted system that senses breathing patterns and delivers mild stimulation to maintain multilevel airway patency during sleep.

Inspire said it's a significant departure from traditional surgical treatments for sleep apnea, such as soft tissue surgery to the tonsils and palate.

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Twitter: @JELagasse

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