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Upper airway stimulation versus untreated comparators in positive airway pressure treatment-refractory obstructive sleep apnea

Rationale: Understand the impact of insurance coverage on sleep apnea outcomes for patients awaiting upper airway stimulation. - - Objectives: Examine the natural history of impact of upper airway stimulation treatment versus insurance denial (comparators) on sleep apnea outcomes. - - Methods: A p...

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Main Authors: Mehra, Reena (Author) , Steffen, Armin (Author) , Heiser, Clemens (Author) , Hofauer, Benedikt (Author) , Withrow, Kirk (Author) , Doghramji, Karl (Author) , Boon, Maurits (Author) , Huntley, Colin (Author) , Soose, Ryan J. (Author) , Stevens, Suzanne (Author) , Larsen, Chris (Author) , Maurer, Joachim T. (Author) , Waters, Tina (Author) , Walia, Harneet K. (Author) , Kominsky, Alan H. (Author) , Trask, Doug (Author) , Schwab, Richard J. (Author) , Thaler, Erica R. (Author) , Strollo, Patrick J. (Author)
Format: Article (Journal)
Language:English
Published: 2020
In: Annals of the American Thoracic Society
Year: 2020, Volume: 17, Issue: 12, Pages: 1610-1619
ISSN:2325-6621
DOI:10.1513/AnnalsATS.202001-015OC
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1513/AnnalsATS.202001-015OC
Verlag, lizenzpflichtig, Volltext: https://www.atsjournals.org/doi/10.1513/AnnalsATS.202001-015OC
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Author Notes:Reena Mehra, Armin Steffen, Clemens Heiser, Benedikt Hofauer, Kirk Withrow, Karl Doghramji, Maurits Boon, Colin Huntley, Ryan J. Soose, Suzanne Stevens, Chris Larsen, Joachim T. Maurer, Tina Waters, Harneet K. Walia, Alan H. Kominsky, Doug Trask, Richard J. Schwab, Erica R. Thaler, and Patrick J. Strollo, on behalf of the ADHERE Registry Study
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Summary:Rationale: Understand the impact of insurance coverage on sleep apnea outcomes for patients awaiting upper airway stimulation. - - Objectives: Examine the natural history of impact of upper airway stimulation treatment versus insurance denial (comparators) on sleep apnea outcomes. - - Methods: A parallel-arm experimental study design was used to compare objective sleep apnea measures and patient-reported outcomes in those who received upper airway stimulation approval versus denial in a multinational prospective study (NCT02907398). Wilcoxon rank-sum test and logistic regression models were used to assess for differences of objective and subjective outcome changes in those who underwent upper airway stimulation versus no treatment comparators. - - Results: A greater reduction in apnea-hypopnea index was observed in those who underwent upper airway stimulation (n = 230, follow-up: 360 ± 171 d) versus no treatment (n = 100, follow-up: 272 ± 278 d), that is, −19.1 ± 15.8 versus −8.1 ± 20.9, respectively, P < 0.001, with consistent findings observed with nocturnal hypoxia measures. Concordantly, a greater improvement noted with subjective measures of dozing propensity was observed in patients undergoing upper airway stimulation versus comparators (Epworth Score, −5.1 ± 5.5 vs. 1.8 ± 3.7, respectively, P < 0.001) and overall sleep-related patient-reported outcomes. Women and those with previous oral appliance use had a lower odds of insurance approval (odds ratio [OR], 0.40; 95% confidence interval [95% CI], 0.22-0.71 and OR, 0.35; 95% CI, 0.18-0.69, respectively). - - Conclusions: Objective and subjective sleep apnea burden was more improved in those receiving upper airway stimulation versus not. Results underscore the need to optimize clinical care pathways focused on effective treatment of patients with obstructive sleep apnea who are not upper airway stimulation-insurance eligible and prioritize public health policy initiatives to address insurance-based sex-specific disparities.
Item Description:Gesehen am 19.07.2024
Physical Description:Online Resource
ISSN:2325-6621
DOI:10.1513/AnnalsATS.202001-015OC

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