title: Healthcare Use in Individuals with Obesity and Chronic Hypoxemia Treated for Sleep Disordered Breathing.
abstract: OBJECTIVE
  To determine if treatment of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) among patients with chronic hypoxemia is associated with reduced healthcare utilization.
  
  
  METHODS
  We performed a retrospective cohort study of 129 obese, hypoxemic patients who underwent polysomnography and were prescribed positive airway pressure (PAP) therapy. During a 2-year follow-up period we examined the associations between adherence to PAP therapy and rates of hospitalization, emergency room (ER) visits, and outpatient visits.
  
  
  RESULTS
  Severe OSA and OHS were common, as were hypertension, cardiovascular, and pulmonary disease. Forty-nine percent of patients were adherent with PAP therapy. Compared to patients who were not adherent to PAP therapy, adherent patients had significantly lower rates of all-cause hospitalization (incident rate ratio [IRR]:0.55, 95% CI 0.33, 0.93) after adjustment for age, sex and hospitalisation rates prior to treatment. Adjustment for additional comorbidities attenuated this association (IRR: 0.61, 95% CI 0.35, 1.06). Adherence with PAP therapy was associated with lower odds of frequent hospitalization (odds ratio 0.23, 95% CI 0.07, 0.73). There were no significant differences in the rates of ER or outpatient visits between adherent and non-adherent patients.
  
  
  CONCLUSIONS
  Adherence with PAP treatment in patients with chronic hypoxemia and chronic medical disorders is associated with reduced rates of hospitalization, which has significant benefit both for patients and the healthcare system.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Marcus
authors.initials: M
authors.lastname: Povitz
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Willis H
authors.initials: WH
authors.lastname: Tsai
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sachin R
authors.initials: SR
authors.lastname: Pendharkar
authors.affiliation: Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Hanly
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
mesh_terms: D002908:Chronic Disease; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010845:Obesity Hypoventilation Syndrome / Q000150:complications / Q000628:therapy; D010349:Patient Compliance; D017286:Polysomnography; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000628:therapy*
keywords: hypoventilation; hypoxemia; obesity; obstructive sleep apnea