Positive Airway Pressure (PAP) Therapy in Obstructive Sleep Apnea (OSA): Modeling of 20 Year Mortality and Hospitalizations

OBJECTIVES: Analysis of an observational German public health insurance database, using propensity score methods, has suggested substantial potential reductions in all-cause mortality and hospitalizations over 4 years among OSA patients treated with PAP therapy. This study applied the previously estimated effects of PAP therapy to estimate potential long-term benefits

METHODS: We estimated elevated non-PAP mortality based on average 4 year expected mortality, and modelled outcomes with and without PAP-treatment, accounting for expected discontinuation from therapy. We applied on-treatment reductions in mortality (HR 0.85, p = 0.046) and hospitalization rates (OR 0.81, p < 0.0001), as previously reported (H.Woerhle, ATS 2023 & 2024), over a 20-year time horizon. Patients (28% female) entered in the model were aged 58 years.

RESULTS: PAP therapy was modeled to potentially avoid substantial numbers of deaths and hospitalizations. Over a period of 10 years, it is projected that PAP therapy could avert 1,800 deaths, gain 0.088 life years, and avoid 7,559 hospitalizations per 100,000 patients. Extending the period to 20 years, the benefits increase significantly, with an estimated 3,362 deaths averted, 0.356 life years gained, and 10,249 hospitalizations avoided per 100,000 patients.

CONCLUSIONS: While subject to the usual limitations relating to observational data, a simple extrapolation of the benefits seen over 4 years in the German data suggests health benefits from PAP therapy could be comparable with those seen in areas such as hyperlipidemia, hypertension, and diabetes in Germany (Gill et al.2024)