Adherence to Positive Airway Pressure Therapy and Healthcare Resource Utilization and Costs Among Patients with Obstructive Sleep Apnea and Obesity

Objective: Obstructive sleep apnea (OSA) and obesity are highly prevalent comorbid conditions associated with major societal and healthcare burden. Positive airway pressure (PAP) therapy is the first-line treatment for OSA. This study evaluated the association between PAP adherence and healthcare resource utilization (HCRU) and costs in patients with OSA and comorbid obesity. Methods: This retrospective cohort study utilized de-identified claims data linked with cloud-connected PAP usage to analyze adults with obesity (ICD-10 code of obesity or morbid obesity or indicating BMI ≥30 kg/m ² ) newly diagnosed with OSA who initiated PAP between 2015 and 2021. Patients were categorized based on adherence: adherent (met Medicare criteria for all quarters), intermediate (adherent for at least one quarter), or nonadherent. Primary outcomes included all-cause emergency room (ER) visits and hospitalizations. Healthcare costs, including inpatient, ER, and total costs, were secondary outcomes. Inverse probability of treatment weighting was applied to balance baseline characteristics across adherence groups. Results: Among 173,691 patients, 35.2% were adherent, 39.1% intermediately adherent, and 25.7% nonadherent. After applying IPTW, in year 1 post-index, adherent patients had significantly fewer ER visits and hospitalizations (0.55 ±1.77 and 0.10 ±0.44) compared to nonadherent patients (0.69 ± 1.78 and 0.14 ± 0.56; P <0.001), and significantly lower total healthcare costs (11,332 ± 21,160 vs 11,927 ± 20,212; P <0.001). Similar findings were observed after 2 years of therapy with adherent patients having lower HCRU and costs than nonadherent patients. Patients with intermediate adherence had outcomes between those of adherent and nonadherent groups, suggesting a dose-dependent effect. Conclusions: Greater adherence to PAP therapy is associated with significantly lower HCRU and costs in patients with OSA and obesity. These findings highlight the importance of identifying and treating OSA in individuals with obesity and implementing strategies to improve PAP adherence, potentially reducing economic and clinical burden.