Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease

Monica M. Vasquez, Leslie A. McClure, Duane L Sherrill, Sanjay R. Patel, Jerry Krishnan, Stefano Guerra, Sairam Parthasarathy

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Chronic Obstructive Pulmonary Disease
Hospitalization
Pressure
Continuous Positive Airway Pressure
Positive-Pressure Respiration
Odds Ratio
Confidence Intervals
Therapeutics
Insurance Claim Review
Propensity Score
Sleep Apnea Syndromes
Mechanical Ventilators
Computational Biology
Respiratory Insufficiency
Causality
Prescriptions
Randomized Controlled Trials
Heart Failure
Delivery of Health Care

Keywords

  • Artificial respiration
  • Chronic obstructive pulmonary disease
  • Continuous positive airway pressure
  • Hospitalization
  • Positive airway pressure therapy
  • Sleep
  • Sleep apnea
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease. / Vasquez, Monica M.; McClure, Leslie A.; Sherrill, Duane L; Patel, Sanjay R.; Krishnan, Jerry; Guerra, Stefano; Parthasarathy, Sairam.

In: American Journal of Medicine, 2017.

Research output: Contribution to journalArticle

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abstract = "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.",
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