OBJECTIVES: Prior studies have demonstrated an association between Obstructive sleep apnea (OSA) and Treatment Resistant Hypertension (TRH) defined as occurrence of overlapping use of ≥4 antihypertensives for a period of greater than 60 days. We sought to evaluate OSA risk in patients with TRH compared to those with treated, but non-resistant hypertension (non-TRH).

METHODS: We conducted a population-based cohort study of patients with treated hypertension (hypertension diagnosis + ≥2 antihypertensive drug claims within 1 year) using IBM MarketScan® commercial claims database from January 2008 to December 2017. We excluded beneficiaries without 12 months of continuous enrollment before the second antihypertensive fill date (index date of cohort entry) and those having the outcome (OSA: identified by ICD codes and a claim of Continuous Positive Airway Pressure) in the 12-month pre-index period. Follow-up started from the index date until the earliest of: first occurrence of OSA, end of continuous enrollment, or study end (December 31^st, 2017). The primary analysis was via Cox regression modeling with OSA as the dependent variable, and time-dependent exposure (non-TRH vs. TRH) and time- dependent covariates (demographic characteristics, clinical comorbidities and healthcare utilization) as independent variables.

RESULTS: Of 2,621,545 patients with treated hypertension (mean-age: 51 years, 50% female), 121,472 met TRH criteria. The crude incidence rates of OSA were 30.5 in TRH patients and 17.6 in non-TRH patients per 1,000 person-years. In unadjusted analyses, TRH was associated with an increased risk of OSA (Hazard Ratio (HR): 1.71; 95% CI, 1.70-1.75). After adjustment for time varying covariates, TRH remained associated with a 57% increased risk of OSA (HR: 1.57; 95% CI, 1.52-1.61) compared to non-TRH. Results remained consistent in sensitivity analyses.

CONCLUSIONS: Our data suggests that patients with TRH are at higher risk of incident OSA. More frequent OSA screening and regular monitoring is needed in this population.