1085 US Healthcare Claims Analysis of Obstructive Sleep Apnea Comorbidities and Their Association with Stimulant Drug Use

• Published in: Sleep (New York, N.Y.) N.Y.), 2018-04, Vol.41 (suppl_1), p.A403-A403
• Main Authors: Ohayon, M M, Profant, J, Gibson, S P, Scheckner, B, Milesi, C
• Format: Article
• Language: English
• Subjects: Comorbidity; Hypertension; Patients; Sampling error; Sleep apnea; Stimulants
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsy061.1084

Abstract Introduction Pathological sleepiness as well as comorbid cardiovascular disease (CVD) are common in obstructive sleep apnea (OSA). In this analysis, comorbidities of patients with OSA were reviewed, along with stimulants and wake-promoting agents (WPAs) prescribed for sleepiness. Methods A retrospective analysis of United States (US) healthcare claims (Symphony Health Integrated Dataverse database) was conducted. Claims contain patient-level data from physician practices, pharmacies, and hospitals linked by patient identifiers (HIPAA compliant). Claims from July-2010 through March-2015 identifying patients with ≥1 diagnostic code for OSA were analyzed to assess demographics, comorbidities, and stimulant/WPA treatment. In this analysis, stimulants were amphetamines/methylphenidate; WPAs were modafinil/armodafinil. Estimated dataset capture: 73% of prescription activity, 55% of medical (non-hospital) claims, and 25% of hospital activity in the US. Results In the 4.75-year period, 12.4 million patients with OSA (mean age, 56 y; 40% female) were identified. Patients with OSA on stimulants/WPAs were younger (mean age, 47 y; 42% female). Comorbidities included hypertension (57%), diabetes (31%), CVD (29%), and major depressive disorder (20%). Five percent had ≥1 stimulant/WPA prescription. Prevalence of comorbidities in all OSA patients was compared with prevalence in those on stimulants/WPAs. In patients with OSA on stimulants/WPAs, comorbid hypertension was identified in 48% and comorbid CVD in 19%. In patients with OSA and comorbid hypertension receiving stimulants/WPAs, 63% received amphetamines/methylphenidate and 46% received modafinil/armodafinil (9% combination); in those with comorbid CVD receiving stimulants/WPAs, 57% received amphetamines/methylphenidate and 52% received modafinil/armodafinil (9% combination). Six percent of patients with OSA and without CVD comorbidities had stimulant/WPA use versus 3.5% of patients with OSA and comorbid CVD. Conclusion In this retrospective claims analysis, hypertension and CVD were common comorbidities in patients with OSA. Stimulant/WPA treatment was observed in OSA patients with and without CVD comorbidities. Presence of hypertension and CVD comorbidities did not appear to relate to stimulant versus WPA selection. Limitations include retrospective study design, lack of confirmed prescribing indications for medication claims, and potential sampling-error bias. Support (If Any) Jazz Pharmaceuticals.