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Volume 15 No. 01
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Accepted Papers





Scientific Investigations

Effects of Adaptive Servoventilation Therapy for Central Sleep Apnea on Health Care Utilization and Mortality: A Population-Based Study

Meghna P. Mansukhani, MD, FAASM1; Bhanu Prakash Kolla, MD, MRPCPsych1,2; James M. Naessens, ScD3; Peter C. Gay, MD, FAASM1,4; Timothy I. Morgenthaler, MD, FAASM1,4
1Center for Sleep Medicine, Mayo Clinic, Minnesota; 2Department of Psychiatry and Psychology, Mayo Clinic, Minnesota; 3Division of Healthcare Policy and Research, Mayo Clinic, Minnesota; 4Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Minnesota

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.

Citation:

Mansukhani MP, Kolla BP, Naessens JM, Gay PC, Morgenthaler TI. Effects of adaptive servoventilation therapy for central sleep apnea on health care utilization and mortality: a population-based study. J Clin Sleep Med. 2019;15(1):119–128.


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