TY - JOUR
T1 - Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease
AU - Vasquez, Monica M.
AU - McClure, Leslie A.
AU - Sherrill, Duane L.
AU - Patel, Sanjay R.
AU - Krishnan, Jerry
AU - Guerra, Stefano
AU - Parthasarathy, Sairam
N1 - Funding Information:
Conflict of Interest: SP reports grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (HL095799 and HL095748), grants from Patient-Centered Outcomes Research Institute (IHS-1306-2505, EAIN #3394-UoA, and PPRND-1507-31666), grants from the US Department of Defense, grants from the NIH (National Cancer Institute; R21CA184920), grants from Johrei Institute, personal fees from American Academy of Sleep Medicine, personal fees from American College of Chest Physicians, nonfinancial support from National Center for Sleep Disorders Research of the NIH (National Heart, Lung, and Blood Institute), personal fees from UpToDate Inc, Philips-Respironics, Inc, and Vaopotherm, Inc, and grants from Younes Sleep Technologies, Ltd, Niveus Medical Inc, and Philips-Respironics, Inc, outside the submitted work. SP also has a patent: UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 (Home Breathing Device). The conflicts including the patent are unrelated to the topic of this article.
Publisher Copyright:
© 2017 The Authors
PY - 2017/7
Y1 - 2017/7
N2 - Background Hospitalization of patients with chronic obstructive pulmonary disease creates a huge healthcare burden. Positive airway pressure therapy is sometimes used in patients with chronic obstructive pulmonary disease, but the possible impact on hospitalization risk remains controversial. We studied the hospitalization risk of patients with chronic obstructive pulmonary disease before and after initiation of various positive airway pressure therapies in a “real-world” bioinformatics study. Methods We performed a retrospective analysis of administrative claims data of hospitalizations in patients with chronic obstructive pulmonary disease who received or did not receive positive airway pressure therapy: continuous positive airway pressure, bilevel positive airway pressure, and noninvasive positive pressure ventilation using a home ventilator. Results The majority of 1,881,652 patients with chronic obstructive pulmonary disease (92.5%) were not receiving any form of positive airway pressure therapy. Prescription of bilevel positive airway pressure (1.5%), continuous positive airway pressure (5.6%), and noninvasive positive pressure ventilation (<1%) in patients with chronic obstructive pulmonary disease demonstrated geographic-, sex-, and age-related variability. After adjusting for confounders and propensity score, noninvasive positive pressure ventilation (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.13-0.27), bilevel positive airway pressure (OR, 0.42; 95% CI, 0.39-0.45), and continuous positive airway pressure (OR, 0.70; 95% CI, 0.67-0.72) were individually associated with lower hospitalization risk in the 6 months post-treatment when compared with the 6 months pretreatment but not when compared with the baseline period between 12 and 6 months before treatment initiation. Stratified analysis suggests that comorbid sleep-disordered breathing, chronic respiratory failure, heart failure, and age less than 65 years were associated with greater benefits from positive airway pressure therapy. Conclusion Initiation of positive airway pressure therapy was associated with reduction in hospitalization among patients with chronic obstructive pulmonary disease, but the causality needs to be determined by randomized controlled trials.
AB - Background Hospitalization of patients with chronic obstructive pulmonary disease creates a huge healthcare burden. Positive airway pressure therapy is sometimes used in patients with chronic obstructive pulmonary disease, but the possible impact on hospitalization risk remains controversial. We studied the hospitalization risk of patients with chronic obstructive pulmonary disease before and after initiation of various positive airway pressure therapies in a “real-world” bioinformatics study. Methods We performed a retrospective analysis of administrative claims data of hospitalizations in patients with chronic obstructive pulmonary disease who received or did not receive positive airway pressure therapy: continuous positive airway pressure, bilevel positive airway pressure, and noninvasive positive pressure ventilation using a home ventilator. Results The majority of 1,881,652 patients with chronic obstructive pulmonary disease (92.5%) were not receiving any form of positive airway pressure therapy. Prescription of bilevel positive airway pressure (1.5%), continuous positive airway pressure (5.6%), and noninvasive positive pressure ventilation (<1%) in patients with chronic obstructive pulmonary disease demonstrated geographic-, sex-, and age-related variability. After adjusting for confounders and propensity score, noninvasive positive pressure ventilation (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.13-0.27), bilevel positive airway pressure (OR, 0.42; 95% CI, 0.39-0.45), and continuous positive airway pressure (OR, 0.70; 95% CI, 0.67-0.72) were individually associated with lower hospitalization risk in the 6 months post-treatment when compared with the 6 months pretreatment but not when compared with the baseline period between 12 and 6 months before treatment initiation. Stratified analysis suggests that comorbid sleep-disordered breathing, chronic respiratory failure, heart failure, and age less than 65 years were associated with greater benefits from positive airway pressure therapy. Conclusion Initiation of positive airway pressure therapy was associated with reduction in hospitalization among patients with chronic obstructive pulmonary disease, but the causality needs to be determined by randomized controlled trials.
KW - Artificial respiration
KW - Chronic obstructive pulmonary disease
KW - Continuous positive airway pressure
KW - Hospitalization
KW - Positive airway pressure therapy
KW - Sleep
KW - Sleep apnea
KW - Sleep-disordered breathing
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U2 - 10.1016/j.amjmed.2016.11.045
DO - 10.1016/j.amjmed.2016.11.045
M3 - Article
C2 - 28089799
AN - SCOPUS:85016612149
SN - 0002-9343
VL - 130
SP - 809
EP - 818
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -