Journal
SLEEP
Volume 43, Issue 12, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/sleep/zsaa122
Keywords
obstructive sleep apnea; continuous positive airway pressure; CPAP; treatment; adherence; Medicare; older adults
Categories
Funding
- ResMed
- AASM Foundation
- Department of Defense
- Merck
- Agency for Healthcare Research and Quality grant [K01HS024560]
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Study Objectives: To examine rates of adherence to continuous positive airway pressure (CPAP) therapy among a representative sample of older adult Medicare beneficiaries with obstructive sleep apnea (OSA), and to identify demographic and health-related factors associated with CPAP adherence. Methods: Using a 5% sample of Medicare claims data, we utilized Medicare policy and CPAP machine charges as a proxy for CPAP adherence. A cumulative logit model was used to identify demographic, medical, and psychiatric predictors of CPAP adherence status. Results: Of beneficiaries who initiated CPAP (n = 3,229), 74.9% (n = 2,417) met the so-called 90-day Medicare adherence criteria, but only 58.8% of these individuals (n = 1,420) continued to use CPAP throughout the entire 13-month rent-to-own period. Anxiety, anemia, fibromyalgia, traumatic brain injury, and lower socioeconomic status (SES) were all associated with reduced CPAP adherence. Conclusions: These results provide the first national estimates of CPAP adherence among older adult Medicare beneficiaries in the United States. In addition, findings highlight the salience of medical and psychiatric comorbidity, as well as SES, as important markers of CPAP adherence among older adults in the United States. Future studies should seek to evaluate interventions to improve CPAP adherence among older adults of lower SES.
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