Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs.

Objective: Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA.
Methods: Administrative claims data were linked to objective PAP therapy usage. Inverse probability treatment weighting was used to compare outcomes over 2 years across PAP adherence levels. The predicted numbers of emergency room (ER) visits and hospitalizations by adherence level were assessed using risk-adjusted generalized linear models.
Results: 37,459 patients were included. Relative to non-adherent patients, consistently adherent patients had fewer self-harm events (0.04 vs 0.05, p < 0.001) after 1 year, and significantly (all p < 0.001) fewer ER visits (0.66 vs 0.86) and all-cause hospitalizations (0.13 vs 0.17), and lower total ($11,847 vs $11,955), inpatient hospitalization ($1634 vs $2274), and ER visit ($760 vs $1006) costs per patient in the second year of PAP therapy. Consistently adherent patients showed lower risk for hospitalizations and ER visits.
Limitations: Using observational claims data, we were unable to assess clinical characteristics including sleep, sleepiness, and daytime symptoms, or important social determinants of health. We were limited in assessing care received outside of the included health plans.
Conclusion: Consistent adherence to PAP therapy over 2 years was associated with improved HCRU outcomes for patients with pre-existing depression newly diagnosed with comorbid OSA.
Competing Interests: Declaration of competing interest EMW's institution has received research support from the AASM Foundation, Department of Defense, Merck, ResMed, and the ResMed Foundation. EMW has served as a scientific consultant to DayZz, Eisai, EnsoData, Idorsia, Merck, Nox Health, Purdue, ResMed, and Primasun, and is an equity shareholder in WellTap. AM is funded by NIH. He reports income related to medical education from Livanova, Jazz, Zoll and Eli Lilly. ResMed provided a philanthropic donation to UC San Diego, but Dr. Malhotra has not received personal income from ResMed or medXcloud. PAC has an appointment to an endowed academic Chair at the University of Sydney that was established from ResMed funding, has received research support from ResMed and SomnoMed, and is a consultant to ResMed, SomnoMed, Signifier Medical Technologies, Bayer, and Sunrise Medical. JLP is supported by the French National Research Agency in the framework of the Investissements d'Avenir program [Grant ANR-15-IDEX-02] and the e-Health and Integrated Care and Trajectories Medicine and MIAI Artificial Intelligence chairs of excellence from the Grenoble Alpes University Foundation. He has received lecture fees or conference traveling grants from ResMed, Philips, Jazz Pharmaceuticals, Agiradom, and Bioprojet. KVC, RBD, KLS are all employees of ResMed. medXcloud is an academic-industry collaboration involving employees and consultants of ResMed and global academic thought leaders in the fields of sleep and respiratory medicine. Representatives of the study sponsor were involved in the study design, collection, analysis, and interpretation of data, writing of the report, and in the decision to submit the paper for publication. Emerson Wickwire had final responsibility for the decision to submit for publication.
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