Sleep and Breathing

, Volume 23, Issue 1, pp 193–200 | Cite as

Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA

  • Gurinder SinghEmail author
  • Amitesh Agarwal
  • Wei Zhang
  • Yong-Fang Kuo
  • Rizwana Sultana
  • Gulshan Sharma
Sleep Breathing Physiology and Disorders • Original Article



Growing evidence supports that patients with chronic obstructive pulmonary disease (COPD) and coexisting obstructive sleep apnea (OSA) have poor prognosis. This association is described as overlap syndrome. Positive airway pressure (PAP) therapy is now the preferred treatment for OSA. We hypothesized that use of PAP therapy in elderly patients with overlap syndrome would be associated with lower healthcare utilization.


In this retrospective cohort study, we analyzed data from 5% national sample of fee-for-service Medicare beneficiaries with a diagnosis of COPD who were newly started on PAP therapy in 2011. We examined the effect of PAP therapy on emergency room (ER) visits and hospitalizations for all-cause and COPD-related conditions in the 1 year pre- and 1 year post-initiation of PAP therapy.


In year 2011, we identified 319 patients with overlap syndrome who were new users of PAP therapy. In this cohort of patients, hospitalization rates for COPD-related conditions were significantly lower in the 1 year post-initiation of PAP therapy compared to the 1-year pre-initiation period (19.4 vs 25.4%, P value = 0.03). However, ER visits (for any cause or COPD-related conditions) and hospitalization rates for any cause did not differ significantly in the pre- and post-initiation periods. PAP therapy was more beneficial in older adults, those with higher COPD complexity, and those with three or more comorbidities.


Initiation of PAP therapy in elderly patients with overlap syndrome is associated with a reduction in hospitalization for COPD-related conditions, but not for all-cause hospitalizations and ER visits.


COPD OSA Overlap syndrome PAP Hospitalization and healthcare utilization 



Acute exacerbation of chronic obstructive pulmonary disease


Apnea-Hypopnea Index


Bronchoalveolar lavage


Congestive heart failure


Confidence interval


Centers for Medicare and Medicaid Services


Chronic obstructive pulmonary disease


Durable Medical Equipment


Emergency room


Health maintenance organization


Hazard ratio


International Classification of Diseases, Ninth Revision


Obstructive sleep apnea


Positive airway pressure



The authors thank Sarah Toombs Smith, PhD, for her help with preparation of the manuscript.

Author contributions

Dr. Gurinder Singh served as principal author, had full access to the data in the study, and takes full responsibility for the content of the manuscript, including accuracy of data analysis.

Dr. Amitesh Agarwal, Mr. Wei Zhang, Dr. Yong-Fang Kuo, Dr. Rizwana Sultana, and Dr. Gulshan Sharma contributed to the conception, study design, analysis, interpretation of results, drafting of manuscript, and final approval of the manuscript.


This work was supported by the Agency of Healthcare Research and Quality [Grant R01-HS020642] and the Patient-Centered Outcomes Research institute [Grant R24HS022134]. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

Dr. Gulshan Sharma served on the advisory board of Sunovion and Mylan Pharmaceuticals. The remaining authors have no potential conflicts of interest related to the content of manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of University of Texas Medical Branch and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not needed due to the nature of the study.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Internal Medicine Residency ProgramSan Joaquin General HospitalFrench CampUSA
  2. 2.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineUniversity of Texas Medical Branch (UTMB)GalvestonUSA
  3. 3.Office of BiostatisticsUniversity of Texas Medical Branch (UTMB)GalvestonUSA
  4. 4.Sealy Center of AgingUniversity of Texas Medical Branch (UTMB)GalvestonUSA

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