Positive Airway Pressure, Mortality, and Cardiovascular Risk in Older Adults With Sleep Apnea Article Swipe

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Diego R. Mazzotti , Lemuel R. Waitman , Jennifer N. Miller , Krishna M. Sundar , Nancy H. Stewart , David Gozal , Xing Song , Sravani Chandaka , Kelechi Anuforo , Lav P. Patel , Daryl Budine , Nathan Hensel , Siddharth Satyakam , Sharla Smith , Dennis Ridenour , Cheryl Jernigan , Charlotte Linton Early , Kyle Stephens , Kathy Jurius , Abbey Sidebottom , Cassandra Rodgers , Hong Zhong , Vino S. Raj , Victor Meléndez , Angie 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 , J. C. Hase , J. Southworth , Éric Larose , Mary F. Davis , Laurel Hoeth , Sandy Strey , Bradley Taylor , Kris Osinski , April Haverty , Alex Stoddard , Sarah Cornell , Phoenix Do , Lucy Bailey , Beth McDonough , Betsy Chrischilles , Ryan M. Carnahan , Brian Gryzlak , Gi-Yung Ryu , Katrina Oaklander , Pastor Bruce , Brad McDowell , Jarrod Field , Abu Saleh Mohammad Mosa , S. Lawson , Jim McClay , Soliman Islam , Vasanthi Mandhadi , Kim S. Kimminau , Jeff Ordway , Bill Stephens , Russ Waitman , Deandra Cassone , Xiaofan Niu , Lisa Royse , Vyshnavi Paka , Lori Wilcox , Janelle Greening , Carol Geary , Goutham Viswanathan , Jim Svoboda , Jim Campbel , Francés , Haddy Bah , Todd Bjorklund , Jackson Barlocker , Josh Spuh , Louisa A. Stark , Mike Strong , Otolose Fahina , Rachel Hess , Jacob Kean , Sarah Mumford , Ainsley Huffman , Annie Risenmay , Olivia Ellsmore , Lissa Persson , Kayla Torres , Sandi Stanford ·

YOU? · · 2024 · Open Access · · DOI: https://doi.org/10.1001/jamanetworkopen.2024.32468

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.

Related Topics

Medicine

Myocardial Infarction

Continuous Positive Airway Pressure

Internal Medicine

Positive Airway Pressure

Emergency Medicine

Percutaneous Coronary Intervention

Optics

Physics

Mechanical Engineering

Engineering

Concepts

Medicine Mace Hazard ratio Myocardial infarction Obstructive sleep apnea Continuous positive airway pressure Proportional hazards model Internal medicine Positive airway pressure Incidence (geometry) Stroke (engine) Retrospective cohort study Emergency medicine Percutaneous coronary intervention Confidence interval Optics Physics Mechanical engineering Engineering

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Type: article
Language: en
Landing Page: https://doi.org/10.1001/jamanetworkopen.2024.32468
OA Status: gold
Cited By: 16
References: 49
Related Works: 10
OpenAlex ID: https://openalex.org/W4402439466

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OpenAlex ID: https://openalex.org/W4402439466

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DOI: https://doi.org/10.1001/jamanetworkopen.2024.32468

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Title: Positive Airway Pressure, Mortality, and Cardiovascular Risk in Older Adults With Sleep Apnea

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Language: en

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Publication year: 2024

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Publication date: 2024-09-11

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Authors: Diego R. Mazzotti, Lemuel R. Waitman, Jennifer N. Miller, Krishna M. Sundar, Nancy H. Stewart, David Gozal, Xing Song, Sravani Chandaka, Kelechi Anuforo, Lav P. Patel, Daryl Budine, Nathan Hensel, Siddharth Satyakam, Sharla Smith, Dennis Ridenour, Cheryl Jernigan, Charlotte Linton Early, Kyle Stephens, Kathy Jurius, Abbey Sidebottom, Cassandra Rodgers, Hong Zhong, Vino S. Raj, Victor Meléndez, Angie 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, J. C. Hase, J. Southworth, Éric Larose, Mary F. Davis, Laurel Hoeth, Sandy Strey, Bradley Taylor, Kris Osinski, April Haverty, Alex Stoddard, Sarah Cornell, Phoenix Do, Lucy Bailey, Beth McDonough, Betsy Chrischilles, Ryan M. Carnahan, Brian Gryzlak, Gi-Yung Ryu, Katrina Oaklander, Pastor Bruce, Brad McDowell, Jarrod Field, Abu Saleh Mohammad Mosa, S. Lawson, Jim McClay, Soliman Islam, Vasanthi Mandhadi, Kim S. Kimminau, Jeff Ordway, Bill Stephens, Russ Waitman, Deandra Cassone, Xiaofan Niu, Lisa Royse, Vyshnavi Paka, Lori Wilcox, Janelle Greening, Carol Geary, Goutham Viswanathan, Jim Svoboda, Jim Campbel, Francés, Haddy Bah, Todd Bjorklund, Jackson Barlocker, Josh Spuh, Louisa A. Stark, Mike Strong, Otolose Fahina, Rachel Hess, Jacob Kean, Sarah Mumford, Ainsley Huffman, Annie Risenmay, Olivia Ellsmore, Lissa Persson, Kayla Torres, Sandi Stanford

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Concepts: Medicine, Mace, Hazard ratio, Myocardial infarction, Obstructive sleep apnea, Continuous positive airway pressure, Proportional hazards model, Internal medicine, Positive airway pressure, Incidence (geometry), Stroke (engine), Retrospective cohort study, Emergency medicine, Percutaneous coronary intervention, Confidence interval, Optics, Physics, Mechanical engineering, Engineering

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Cited by: 16

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