PAP Therapy Linked to Decreased Heart Failure, Attacks

TOPLINE:
The utilization of positive airway pressure (PAP) therapy is associated with reduced rates of mortality and incidence of major adverse cardiovascular events (MACEs) in older adults with obstructive sleep apnea (OSA), with a greater utilization further reducing these risks.
METHODOLOGY:
Researchers conducted a retrospective clinical cohort study including 888,835 older adults (median age, 73 years; 43.9% women) with at least two distinct OSA claims from 2011 to 2020.
On the basis of the first claim after OSA diagnosis, 290,015 patients had evidence of initiation of PAP therapy.
The primary outcomes were all-cause mortality and MACEs, defined as a composite of the first occurrence of myocardial infarction, heart failure, stroke, or coronary revascularization.
MACEs were analyzed in 555,107 patients who did not have any history of such events before OSA diagnosis or initiation of PAP therapy.
TAKEAWAY:
Initiation of PAP therapy was associated with a 47% lower risk for all-cause mortality (hazard ratio [HR], 0.53; 95% CI, 0.52-0.54) and a 10% lower risk for MACEs (HR, 0.90; 95% CI, 0.89-0.91).
For MACE-specific events, incidences of heart failure and myocardial infarctions were lower among those who initiated PAP therapy (21.2% vs 18.3% and 10% vs 8.6%, respectively; P < .001). Incidence rates were minimal or slightly raised for stroke (no PAP, 8.2% vs PAP, 8%; P = .001) and coronary revascularization (no PAP, 4.5 vs PAP, 4.7%; P < .001).
Higher quartiles of annual claims for PAP therapy were progressively associated with lower rates of mortality and incidence of MACEs.
The protective associations of PAP initiation were more prevalent among women, those with obesity and atrial fibrillation, and those without hypersomnia.
IN PRACTICE:
“This study has the potential to inform future trials assessing the importance of OSA therapy initiation and maintenance toward minimizing adverse health outcomes leading to healthier lives. These results may also help to inform more personalized strategies to improve PAP adherence and efficacy among older adults,” the authors wrote.
SOURCE:
This study was led by Diego R. Mazzotti, PhD, of the Department of Internal Medicine at The University of Kansas Medical Center in Kansas City, Missouri, and was published online on September 11, 2024, in JAMA Network Open.
LIMITATIONS:
The study’s reliance on diagnostic codes prevented an accurate characterization of disease severity. The study also lacked detailed information about body mass index, blood pressure, and laboratory measurements, which could have affected the results. This study focused only on Medicare beneficiaries in the central United States, which limited generalizability to other demographics.
DISCLOSURES:
The study was funded by the American Heart Association, Patient-Centered Outcomes Research Institute, University of Kansas Clinical and Translational Science Institute, and other sources. Some authors declared receiving grants and personal fees, serving as an advisory board member, and having other ties with several sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed and edited this content before publication.
 
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