Impact of diagnosing and treating obstructive sleep apnea on healthcare utilization

Purpose: Obstructive sleep apnea (OSA) contributes to an increased risk for multiple co-morbidities and decreased quality of life. As a result, OSA patients may have higher usage of healthcare resources which can be mitigated with effective treatment. This study evaluates changes in healthcare utilization (HCU) following the initiation of therapy for OSA. Methods: We conducted a retrospective study of newly diagnosed OSA patients. To assess total HCU, we incorporated the sum total of outpatient clinic encounters, laboratory tests, and medication prescriptions into a composite HCU score. Healthcare utilization for twelve months prior to positive airway pressure (PAP) was compared with twelve months after initiation of therapy. Reductions in HCU were correlated with PAP adherence. Results: 650 consecutive patients were included. Mean age, gender, BMI, AHI, and ESS were 47.2 +/- 8.8 years, 77.2% (men), 30.7 +/- 4.9 kg/m(2), 37.1 +/- 30.3, and 13.1 +/- 5.1, respectively. Prior to PAP, mean outpatient visits, laboratory studies, medication prescriptions, and HCU composite score were 11.6 +/- 10.4, 13.7 +/- 11.0, 4.7 +/- 3.2, and 29.7 +/- 18.6, respectively. Following initiation of treatment, a 32.8% reduction in non-sleep outpatient visits was identified (p = 0.01) and a 16.4% decrease in laboratory studies (p = 0.02) was observed. There was a 19.9% reduction (p = 0.002) in HCU composite score. Those who were adherent with PAP had a 25.7% reduction in HCU composite score versus a 4.9% increase in those who discontinued PAP therapy (p < 0.001). Conclusions: Diagnosing OSA and initiating PAP therapy resulted in a significant decrease in healthcare resource utilization. This reduction was greatest among those with higher baseline healthcare usage and those most adherent with therapy. Published by Elsevier B.V.