New study links non-adherence to CPAP therapy to hospital readmissions

DARIEN, Ill. - Non-adherence to CPAP therapy is significantly associated with increased 30-day hospital readmissions, according to a study of patients with obstructive sleep apnea published in the Feb. 15 issue of Journal of Clinical Sleep Medicine.

Non-adherent patients were three times more likely to be readmitted to the hospital within 30 days for any cause, the study shows.

"Until now no one has investigated the role of CPAP non-adherence in 30-day readmissions as an independent risk factor in all types of admissions," said principal investigator Dr. Behrouz Jafari, director of the sleep program at the Veterans Affairs Long Beach Healthcare System in Long Beach, California, and assistant professor of medicine in the section of pulmonary and critical care medicine at the University of California, Irvine. "This study carries important implications as it suggests that CPAP therapy may be an important, modifiable target for reducing hospital readmissions.”

The leading cardiovascular causes for readmission in these patients were atrial fibrillation, myocardial ischemia and congestive heart failure, all of which are linked to untreated sleep apnea, the study says.

The study involved 345 patients with obstructive sleep apnea who were hospitalized at a VA medical center from Jan. 1, 2007, to Dec. 31, 2015. Ninety-five percent of participants were men, and 72% were white. The 183 adherent patients had an average age of 66 years, and the 162 non-adherent patients had an average age of 62 years. Mean sleep apnea severity was severe in both groups.

Objective CPAP data were analyzed according to the Medicare definition of CPAP adherence, which is CPAP use for four or more hours per night on 70% of nights during a consecutive minimum period of 30 days. Results were adjusted for potential confounders such as age, sex, body mass index, living situation, race, comorbidities, and medication adherence.

Jafari noted that 30-day readmissions are touted as the key quality indicator for hospitals and a way to reduce healthcare costs.

"Improving CPAP adherence may have a cost-saving effect at local, state-based and national levels," he said.