Meghna P Mansukhani1, Bhanu Prakas Kolla1,2, James M Naessens3, Peter C Gay1,4, Timothy I Morgenthaler1,4. 1. Center for Sleep Medicine, Mayo Clinic, Minnesota. 2. Department of Psychiatry and Psychology, Mayo Clinic, Minnesota. 3. Division of Healthcare Policy and Research, Mayo Clinic, Minnesota. 4. Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Minnesota.
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.
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.
Authors: T Douglas Bradley; Alexander G Logan; R John Kimoff; Frédéric Sériès; Debra Morrison; Kathleen Ferguson; Israel Belenkie; Michael Pfeifer; John Fleetham; Patrick Hanly; Mark Smilovitch; George Tomlinson; John S Floras Journal: N Engl J Med Date: 2005-11-10 Impact factor: 91.245
Authors: Timothy I Morgenthaler; Tomasz J Kuzniar; Lisa F Wolfe; Leslee Willes; William C McLain; Rochelle Goldberg Journal: Sleep Date: 2014-05-01 Impact factor: 5.849