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

摘要

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 hight 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 1.093.01, 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.